In this issue of Nursing Outlook,in the article “Mapping Geriatric Nursing Competencies to the 2001 NCLEX-RN Test Plan,” Ann Wendt addresses the very important issue of geriatric content on the National Council of State Boards of Nursing (NCSBN) NCLEX examination.
Older adults already constitute the bulk of a nurse’s patient caseload. As Wendt points out, newly licensed nurses report that older patients currently make up 62.5% of their patients. It is safe to say that older adults form the core business of health care, since close to 50% of patients in hospitals, 85% of home care patients, and more than 90% of residents of nursing homes are age 65 years or older. As the number of older Americans rises exponentially in the years ahead, the need to take care of a larger proportion of older, and potentially sicker, patients poses enormous challenges for the future of hospitals and community and institutional long-term care health options.
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Emphasizing aging aligns the interests of the NCSBN with a growing movement in nursing education to ensure a nurse workforce prepared to care for an aging patient population. During the past 5 years, with substantial support from the John A. Hartford Foundation (www.GerontologicalNursing.info), the Atlantic Philanthropies, the Hearst Foundation, the Health Resources and Services Administration, and others, nursing education has made considerable strides in strengthening geriatric content and in ensuring competence in baccalaureate graduates. These efforts include publication of baccalaureate geriatric competencies and curriculum materials; faculty development at the clinical, predoctoral, and postdoctoral levels; and support and awards for innovative educational models.
Wendt’s article is a signal to nursing education that the NCSBN takes seriously its commitment to ensure adequate geriatric content on the NCLEX examination. This is of great importance to patient care because data support that patients cared for by nurses and other health care providers knowledgeable about geriatrics have better outcomes, including fewer complications, fewer untoward events, shorter hospital stays, and less recidivism.
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Attention to geriatrics by the NCSBN is a “wake-up” call to nursing programs to guarantee a curriculum focused on care of older patients. In 1998, only 37% of baccalaureate nursing programs had a free-standing course in geriatrics (23% had a required course).
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Even when geriatric content was integrated into the curriculum, few programs reported that any course devoted greater than 25% of the content to care of older adults. Although we are optimistic that these numbers have increased during the past 5 years, additional efforts must be made to ensure that clinical expertise related to care of the older adult be strengthened in all baccalaureate nursing programs.The findings of NCSBN’s preliminary study suggest several steps. It would be important to map the actual content of the NCLEX examination questions to the Recommended Baccalaureate Competencies and Curricular Guidelines for Geriatric Nursing Care (American Association of Colleges of Nursing and the John A. Hartford Foundation Institute for Geriatric Nursing, 2000) to ensure that each area is covered in sufficient depth and specificity. In addition, tracking student performance on the NCLEX examination before and after introduction of geriatric content into the curriculum could provide valuable data for structuring or restructuring content and experiences related to the older adult. Finally, the NCSBN’s Practice Analysis of Newly Licensed Registered Nurses in the United States could serve as an important tool for studying trends in nursing care that would, in turn, help ensure the development and evaluation of relevant nursing curricula and testing for practice. These additional resources and foci will ensure a nurse workforce prepared to meet the future needs of the health care system and society at large.
References
Buerhaus P. Relationship between hospital nurse staffing and quality outcomes. Presented at: Sixth Annual National Magnet Nursing Conference; Oct 13-15, 2002; Mayo Clinic, Rochester, MI
- A controlled trial of inpatient and outpatient geriatric evaluation and management.N Engl J Med. 2002; 346: 905-912
- Nurses improving care for health-system elders (NICHE).Geriatr Nurs. 2002; 23: 121-127
- A randomized trial of care in a hospital medical unit especially designed to improve the functional outcomes of acutely ill older patients.N Engl J Med. 1995; 332: 1338-1344
- Comprehensive discharge planning and home follow-up of hospitalized elders.J Am Med Assoc. 1999; 281: 613-620
- Gerontological nursing content in baccalaureate nursing programs.J Prof Nurs. 1999; 15: 84-94
Biography
Geraldine Bednash is executive director of the American Association of Colleges of Nursing and director of the John A. Hartford Foundation Geriatric Nursing Education Projects at AACN.
Claire Fagin is former dean of the University of Pennsylvania School of Nursing and is director of the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Program at the American Academy of Nursing.
Mathy Mezey is an Independence Foundation professor of Nursing Education and director of the John A. Hartford Foundation Institute for Geriatric Nursing at New York University, Steinhardt School of Education, Division of Nursing
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© 2003 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
