Guest Editorial: Building academic geriatric nursing capacity: The JAHF/AAN partnership

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Established in 1929, the John A. Hartford Foundation represents the legacies of John and George Hartford, sons of George Huntington Hartford, founder of the Great Atlantic and Pacific Tea Company, better known as the A&P grocery store chain. Their mandate to the Foundation was to “carve from the whole vast spectrum of human needs one small band that the heart and mind together tell you is the area in which you can make your best contribution.” For the past 25 years, this has led Hartford’s Trustees to increase the nation’s capacity to provide quality and affordable care to its rapidly growing elderly population.

Older people need this care because they have more disease and disability than younger adults. Often these diseases are chronic and coexist with other diseases. Disease and disability can greatly limit independence and increase the need for support. Older adults represent one third of people admitted to the hospital and, at any time, almost half of the people in the hospital are 65 or older. Of the nearly 36 million Americans aged 65 or older, about 7 million rely on a caregiver’s daily assistance.

The rapidly growing population of older people will increase the pressure on health professionals and the health care system to provide quality care. As the baby boomers (those born between 1946 and 1964) age, our over-65 population will double to 70 million by 2030, and the US Census Bureau projects that the population age 85 and over could grow from 4.2 million in 2000 to nearly 21 million by 2050. Centenarians are expected to grow even faster, from 72,000 in 2000 to 834,000 in 2050.

As the baby boomers reach their 60s, 70s, and beyond, there will be a dramatic increase in the demand for nurses. This, unfortunately, will take place as the nation faces a serious nursing shortage. The US Bureau of Labor Statistics reports that more than one million new and replacement nurses will be needed by 2012, and for the first time, the US Department of Labor has identified Registered Nursing “as the top occupation in terms of job growth through the year 2012.” The Health Resources and Services Administration projects that the shortage will intensify over the next two decades, with 44 states plus the District of Columbia expected to have RN shortages by the year 2020. This crisis faces the nursing profession, colleges and universities that educate nurses, governments at all levels, and the philanthropic community.

Committed to addressing this challenge, the Hartford Foundation has pledged $60 million since 1996 to strengthen the geriatric nursing enterprise. In 1996, Hartford’s Trustees awarded a five-year grant to New York University to create the John A. Hartford Foundation Institute for Geriatric Nursing. As our first major nursing grant, the institute focused on raising the visibility of geriatric nursing as well as improving geriatric nursing education, practice, and research nation wide. The 2001 renewal of the grant has tried to capitalize on the national concern regarding nurse staffing and quality and build synergy with other Hartford nursing programs.

The Building Academic Geriatric Nursing Capacity (BAGNC) initiative, the focus of this special issue of Nursing Outlook, was funded to address the critical shortage of leaders in geriatric nursing research and education. This initiative created five Centers of Geriatric Nursing Excellence, stipends for predoctoral and postdoctoral trainees and MBA candidates, and seven projects comprising the Nursing School Geriatric Investment Program. A major grant to the American Academy of Nursing (AAN) in July 2000 provided oversight, development, and coordination of the entire initiative and funded the AAN to administer the scholarship and investment programs. Figure 1 outlines the entire Hartford Foundation funded geriatric nursing initiative; however, for purposes of this paper the BAGNC program is highlighted.

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• Figure 1. 

  The John A. Hartford Foundation

In 2005, grants to the five Centers of Geriatric Nursing Excellence were re-funded and the AAN grant was renewed and expanded. This renewal will continue to build academic geriatric nursing capacity through predoctoral, MBA scholar, and postdoctoral recruitment; selection and support; leadership development; interdisciplinary research; collaborations among Hartford Foundation funded geriatric nursing projects; and dissemination. Because a major goal of this initiative is to create sustainable change in schools of nursing and health care systems, the project will focus on leadership development in education, research, and practice. Among the initiative’s activities will be the development of a geriatric research agenda and broad national dissemination of BAGNC activities and products.

In 2001, The Measurement Group was funded to undertake an evaluation of all of the Foundation’s nursing projects. This grant was renewed in 2004. To extend and intensify the Foundation’s geriatric nursing initiatives, Hartford’s Trustees also awarded two grants in 2001 to the American Association of Colleges of Nursing (AACN). The objective of the first project was to create a national program of grants to increase the geriatric content of nursing education and training at the baccalaureate and advance practice levels. The project provided awards to 20 baccalaureate and 10 advanced practice programs to encourage the development of curricula focused on the care of older adults. The project also developed and publicized national standards for nursing competencies in the care of older people. The purpose of the second grant was to increase the number of advanced practice nursing students who specialize in geriatrics. This project was renewed for four years in 2004. In 2005, the AACN was funded to develop a national initiative to prepare up to 700 tenure-track baccalaureate faculty to lead the transformation of their school’s curricula and to teach and mentor colleagues and students in geriatric nursing. The objectives of the program are to increase gerontology content in senior-level undergraduate nursing courses and educate faculty at a majority of the baccalaureate schools of nursing across the country in the fundamentals of geriatric nursing and the use of geriatric curriculum resources.

The Trustees and staff of the John A. Hartford Foundation take great pride in this special issue of Nursing Outlook. The astounding accomplishments of the BAGNC initiative have far exceeded our expectations. Every Center of Geriatric Nursing Excellence has built strong programs that have significantly expanded the cadre of future geriatric nursing leaders. Although the five centers differ in the ways they have chosen to implement their programs, each of them has creatively developed their strengths to enhance clinical practice and models of care, improve education and training, implement better treatment methods, conduct research, and positively affect healthcare policies. These innovative practices, materials, and models are available for every school’s use and improvement. Equally important are the linkages and partnerships that have developed in geriatric nursing among and between the centers, other Hartford-funded programs, nursing schools at other colleges and universities, and the Foundation. Centers cooperate and collaborate enthusiastically with each other and their partners. They generously share their major programmatic ideas, findings, and products through publications and presentations and work hard to provide national leadership for the field of geriatric nursing. Finally, all of the centers have leveraged their designation as Hartford Centers of Geriatric Nursing Excellence to obtain approximately $40 million in outside funding.

George Huba, the independent evaluator and lead author of this issue’s final paper “Outcomes and lessons learned from the Building Academic Geriatric Nursing Capacity Initiative,” has concluded “that for its funding level, this program is an exceptional one that has greatly exceeded reasonable expectations.” He found the activities to have been “systematic and of exceptional quality” and that the models “should be transportable to other Schools of Nursing.” However, the true test of the success of this initiative will be whether these advances can be sustained at the funded institutions and adopted at other nursing schools around the country and whether the health care of our older population is improved over the long term.

The Hartford Foundation’s Board and staff are deeply indebted to Claire Fagin, the intellectual and programmatic leader of this initiative, and to Patty Franklin, who deftly managed the project. Every one of the Center’s five leaders—Pat Archbold, Claudia Beverly, Jeanie Kayser-Jones, Meridean Maas, and Neville Strumpf—have been outstanding; without them this initiative would never have succeeded.