Faculty Bibliography

Attempts to address the nursing shortage must consider the aging nursing supply and the decreased labor participation among nurses at age 55 and older. Efforts to retain older, experienced nurses have been meager, and little attention is paid to the role of eldercare in decisions to leave the profession. This pilot study examines current workplace practices that may contribute to early withdrawal of older nurses from the hospital workforce. Interviews with 28 elder caregiving registered nurses and assistive nursing personnel at a New York hospital were conducted. Respondents reported that successful management of their dual roles rests on identifying units and shifts that suit their needs, erecting clear boundaries between home and work, and their love of nursing. "Caregiver-friendly" practices such as creative, flexible scheduling; access to social workers; financial and legal services; and increased awareness among managers about caregiver strains were recommended.

The Practicum Partnership Program (PPP), an innovative field education model developed and implemented by six demonstration sites over four years (2000-2004), uses a structured university-community partnership, or consortium, as the foundation for designing, implementing, and evaluating internships for graduate social work students specializing in aging. This paper describes the site consortia and PPP programs, presents evaluation findings, and identifies future directions for the PPP. Student learning outcomes were positive and both students and consortia agencies reported positive PPP experiences. The PPP model underscores the value of the community agencies as equal partners in educating future geriatric social workers.

Medicare and Social Security often are assumed to provide universal coverage for the population age 65 and older. Evidence from New York City raises doubts. Data from the Statewide Planning and Research Cooperative System, the Centers for Medicare and Medicaid Services, the Social Security Administration, and the U.S. Bureau of the Census provide evidence that 16% to 20% of New York City residents age 65 and older lack such coverage. Noncoverage is not unique to this city, but it may be particularly common there. Noncoverage is pronounced in, but not limited to, certain immigrant groups. Because the population share covered by Medicare increases with age and most hospitalizations not covered by Medicare are paid by Medicaid, Medicaid gradually may be replacing Medicare as the payer for hospitalizations for a substantial share of the 65+ population in New York City.

In 2003, the John A. Hartford Foundation Institute for Geriatric Nursing (Hartford Institute), in collaboration with the American Association of Colleges of Nursing, conducted a survey of baccalaureate schools of nursing in the United States to compare gerontological content to baseline data collected by the Hartford Institute in 1997. Since last surveyed in 1997, baccalaureate nursing programs have been the recipients of substantial new resources and initiatives focused on gerontological curriculum enhancement. While these initiatives are ongoing, and some are in an early stage of development, resurveying baccalaureate programs was seen as a means of taking a midcourse "pulse" as to the effectiveness of these efforts. Data suggest that there has been a fundamental shift in baccalaureate curriculum toward incorporation of a greater amount of gerontological content, integration of gerontological content in a greater number of nursing courses, and more diversity of clinical sites used for gerontological clinical experiences. As baccalaureate programs increasingly address the need to enhance gerontological nursing curricula, there continues to be an obligation to address the growing shortage of faculty with qualifications in gerontological nursing.

The 1997 Medical Expenditure Panel Survey (MEPS) data report that approximately 80 million adult ambulatory visits are made to nursing personnel. Adults who visit nursing personnel and who visit physicians are similar with regard to sex and income. As compared to nursing personnel, physician visits are longer and more likely to involve diagnosis or treatment. Older adult visits (ages 65 to 90) to nursing personnel are significantly longer than the visits of younger adults. As compared to physician visits, nursing personnel visits are significantly more likely to be characterized as 'other' for all adults and especially for older adults. Although these findings suggest important differences between physician and nurse ambulatory care visits, the undifferentiated use of the term nurse and the significant percentage of uncharacterized visits to nursing personnel signal serious deficiencies in the MEPS data in exploring nonphysician ambulatory care

The Nurse Residency Program (NRP) at new York University Hospitals Center id predicated on the idea that acute care settings are facing continued challenges in recruiting and retaining nurses in the face of cyclical nursing shortages, increased opportunities in ambulatory and community-based nursing, and an increasingly complex and demanding hospital environment. Baccalaureate education is the required preparation for such a setting; however, a transition for the new graduate is imperative. The authors present the findings of a follow-up survey of completers of the NRP between 1996 and 2001 focusing on the strengths and weaknesses of the programs, as well as suggestions for future programming

OBJECTIVES: The objective of this study was to determine the national practice patterns of nurse practitioners (NPs) providing care in long-term care (LTC) facilities, including the number and characteristics of LTC facilities that use NPs for any portion of care to residents, NP activities, and employment arrangements between NPs, physicians, and facilities. DESIGN: Mailed survey. PARTICIPANTS: Participants included all physicians who are members of the American Medical Directors Association (AMDA). MEASUREMENT: The survey instrument was constructed to obtain information in the following six domains: (1) the number of LTC facilities that have NPs involved in providing care; (2) the number of NPs engaged in care at these facilities; (3) the types of employment/financial arrangements between NPs and LTC facilities; (4) the types of services provided by the NPs; (5) the effectiveness of the NPs as perceived by the medical directors; and (6) the perceived future demand for NPs in LTC. RESULTS: Of a total of 870 respondents (response rate 19%), 546 respondents (63%) reported the involvement of NPs in the care of residents in their facilities. In total, respondents identified 1160 NPs involved in care, with a median of two NPs per responding facility (range, 1-10). Respondents reported that NPs make sick/urgent resident visits (96%), provide preventive care to long-stay residents (88%), and perform alternating required regulatory 30/60 (88%), hospice care (80%), and wound care (78%). Significant variations in practice patterns were found between NPs employed by a LTC facility (19% of respondents) as compared with those NPs employed in other arrangements. Large majorities of medical directors stated that NPs are particularly effective in maintaining physician satisfaction (90%), resident satisfaction (87%), and family satisfaction (85%). An additional 34% of the respondents projected an increased need for NPs in nursing homes in the future. CONCLUSION: NPs involved in LTC are more likely to be involved in the care of residents in the nation's larger (>100-bed) LTC facilities. The substantial number and types of services provided by these NPs, coupled with the high resident, family, and physician satisfaction with their services, suggests the need for educational, policy, and reimbursement strategies to encourage the further involvement of NPs in the care of residents in nursing homes.