HGNI New Directions

Welcome to the third issue of New Directions, a publication of the Hartford Geriatric Nursing Initiative (HGNI). This e-newsletter is designed to inform interested academic and practice leaders, faculty members, students, practitioners and others about the work of the HGNI and provide the latest news and information relevant to geriatric nursing.

As many of you know, the HGNI is preparing professional nurses to play leadership roles in improving the health of older adults. In partnership with the nation's nursing schools and a variety of health care organizations and systems, this dynamic, national Initiative, supported through a $34 million investment from the John A. Hartford Foundation, works in five areas, including:

Shaping nursing practice to best meet the health care needs of older adults;

Enhancing professional education to ensure all nurses are prepared to treat older patients;

Promoting research needed to guide the care and promote the health of older people;

Developing leadership in academic and professional settings; and

Demonstrating nursing's commitment to enacting public policy that improves older Americans' health care.

We are proud to represent this critically needed effort, which is involving the nation's top nurses—including you—in making a difference in the health care of our nation's older adults. If you would like more contact information about, and links to all of the programs of the HGNI, please see the HGNI's Evaluation Web site at www.geriatricnursing.info.

In this Issue

1. Studies Showing Impact of Lower Nurse Staffing Levels on Patient Outcomes Particularly Disturbing for Older Patients
2. Announcements
3. Tools, Resources and Opportunities
4. HGNI People
5. HGNI Link of the Month

1. Studies Showing Impact of Lower Nurse Staffing Levels on Patient Outcomes Particularly Disturbing for Older Patients

The Agency for Healthcare Research and Quality recently issued a new synthesis of research studies funded by AHRQ and others that indicates that hospitals with lower nurse staffing levels, nurses who spent less time with patients, or fewer registered nurses compared with licensed practical nurses or nurses' aides tend to have higher rates of poor patient outcomes, including pneumonia, shock, cardiac arrest, and urinary tract infections. This situation is particularly troubling in light of our aging society and the growing number of older patients who will require nursing care, and the aging of the nursing workforce. This issue is likely especially relevant for gerontological nurses in the large number of acute and chronic care settings where conditions such as pneumonia, shock, cardiac arrest, and urinary tract infections are prevalent in the older patient population.

The six studies reviewed for the synthesis found different rates of adverse events, depending on the reason for the hospitalization (medical or surgical), as well as other factors. Three of the studies found that pneumonia rates are particularly sensitive to nurse staffing levels, which were measured as the ratio of nurses to patients or nursing hours per patient per day.

Several studies indicated that nurse staffing levels may also be associated with mortality rates. Two studies showed that the 30-day mortality rate and the likelihood of failure to rescue are higher when nurse staffing levels are lower. Another showed that a higher proportion of more highly educated nurses can reduce the 30-day mortality rate and the odds of failure to rescue. Closely related to the issue of nurse staffing level is patient acuity - the level of care and services needed by the patient. One study adjusted the total number of patient days of in-hospital care by the severity of illnesses, and showed that as patient acuity rose while nurse staffing levels remained the same, the ratio of nurses to patient days therefore declined.

Another important finding was that increasing nurse staffing levels does not significantly decrease a hospital's profits, in contrast to increases in non-nurse staffing. Furthermore, the costs associated with adverse events that might otherwise be avoided are considerable.

The report, the latest in a series of Research in Action syntheses titled "Research in Action: Hospital Nurse Staffing and Quality of Care," is meant to provide decision makers with the information they need to make more informed choices about nurse staffing levels. It is available online at http://www.ahrq.gov/research/nursestaffing/nursestaff.htm, from the AHRQ Publications Clearinghouse at (800) 358-9295, or by sending an e-mail to ahrqpubs@ahrq.gov.

2. Announcements

McCann Foundation Recognizes Geriatric Scholar
Dr. Mary Naylor of The University of Pennsylvania School of Nursing has been named a McCann Scholar by the Joy McCann Foundation. Modeled after the MacArthur Fellowships, this award carries a $150,000 cash prize recognizing the recipient's "success as an educator and mentor in teaching, research or patient care."

In making the announcement, the McCann Foundation said, "Dr. Naylor has garnered a national and international reputation as a geriatric scholar combining her humanistic concern and respect for vulnerable elders and their caregivers with rigorous science to create innovative models to enhance the care and health outcomes of this population. This pioneering scholar has also earned the respect of her students and peers as an outstanding teacher and mentor. Especially noteworthy is the leadership and dedication she has demonstrated in promoting educational and research collaborations among scholars and students from various disciplines."

Building Academic Geriatric Nursing Capacity Scholar Program
The John A. Hartford Foundation's Building Academic Geriatric Nursing Capacity Scholar program has selected 21 new nurse scholars to receive up to $100,000 each to support their studies and research in the field of geriatric nursing.

These nurse scholars, 13 pre-doctoral and eight post-doctoral, were chosen through a national competition as part of the Hartford Foundation's initiative aimed at building academic geriatric nursing capacity. The 2004 Scholars join 61 colleagues selected since the program began in 2000, with 17 scholars having successfully completed the two-year award program in 2003. To date, the Foundation has invested over $9.28 million in scholarships for nurses through this program.

For further information regarding the Building Academic Geriatric Nursing Capacity Program and a PDF file of the 2005 Scholar Applications, go to www.geriatricnursing.org or call (202) 651-7242 or contact Program Manager Patricia D. Franklin, MSN, RN, at (202) 651-7047 or pfrankli@ana.org.

Enhancing Nursing Education for Baccalaureate and Advanced Practice Nursing Programs
Since 2001, the American Association of Colleges of Nursing (AACN) has administered the John A. Hartford Foundation Geriatric Nursing Education Project, which includes the Enhancing Nursing Education for Baccalaureate and Advanced Practice Nursing Programs. Through this program, 30 institutions have received funds to improve their geriatric nursing curricula. Awards recipients have created highly impressive and innovative courses for their nursing programs.

During the next several months, AACN will showcase and disseminate the models and lessons created through this project. We encourage nursing faculty and administrators to use these articles as a resource to help replicate, develop, and/or expand upon the awardees' fine work. The first highlighted program, The Legal, Ethical and Societal Issues on Aging at the University of Delaware, is posted on the AACN web site at: http://www.aacn.nche.edu/Education/Hartford/ShowcasingInnovation.htm.

3. Tools, Resources and Opportunities

7th Annual Hartford Institute Geriatric Nursing Research Scholars Program July 12-16, 2004 New York University, Division of Nursing
The John A. Hartford Foundation Institute for Geriatric Nursing at New York University is pleased to announce the selection of 17 Hartford Institute Scholars for the 7th Annual Geriatric Nursing Research Scholars Program, to be held July 12-16, 2004. In addition, the Institute welcomes the American Journal of Nursing as a co-sponsor of the program.

The goals of this program are to foster successful programs of gerontologic research with significant implications for practice; to assist in the refinement of a program of significant research; and to hone specific research skills and gain a competitive edge for funding.

Applications for 2005 will be posted in the Fall 2004. To read more, go to: http://www.hartfordign.org/research/scholarsFellows/index.html.

Decades of Focus: Grant Making at The John A. Hartford Foundation
"Decades of Focus: Grant Making at The John A. Hartford Foundation" by Donna I. Regenstreif, Christopher A. Langston, and Corrine H. Rieder, was published in the March/April 2004 issue of Health Affairs. The essay describes the grant-making process at the Foundation, particularly how it engages in strategic thinking in pursuit of realistically achievable goals within a challenging health care environment. For the full article, see Health Affairs. 23(2):258-64, 2004 Mar-Apr.

HRSA Announces Grants
The Health Resources and Services Administration has announced funding for "Clinical Experience in Federally Funded Community Health Centers for Nurse Practitioners and/or Nurse Midwifery Students" Application materials are available at www.hrsa.gov/grants.htm.

Interested in community-campus partnerships and not yet a member of Community-Campus Partnerships for Health (CCPH)? Learn more and join at www.ccph.info.

CCHP's purpose is to establish partnerships between accredited schools of nursing and a Community Health Center (CHC) funded under the Section 330(e) of the Consolidated Health Center Program, Public Health Service (PHS) Act. The partnerships should provide nurse practitioner and/or nurse midwifery graduate students with clinical learning experiences within CHCs. The goal of the grant is to provide nurse practitioner and nurse midwifery students with clinical experience serving underserved populations, to introduce the students to chronic disease management, and to introduce them to integrated mental health and substance abuse services within the CHC's primary care clinics. Based on increased exposure to nurse practitioner and nurse midwifery students, an expected outcome of this grant includes increased CHC recruitment of graduate nurse practitioners and nurse midwives.

Eligibility: Applicants must either be an accredited School of Nursing with a Nurse Practitioner or a Nurse-Midwifery Program, or a CHC funded under Section 330(e) of the PHS Act.

Estimated Amount of This Competition: $250,000 Estimated Number of Awards: 10 Estimated Project Period: 1 year Application Availability: May 3, 2004 Letter of Intent Deadline: not required Application Deadline: June 7, 2004 Projected Award Date: prior to September 30, 2004

For more information, contact Carolyn Aoyama, MPH, CNM, RN, at 301-443-1272 or at caoyama@hrsa.gov.

"Try This" Dementia Series
Brief Evaluation of Executive Dysfunction: An Essential Refinement in the Assessment of Cognitive Impairment

The John A. Hartford Foundation Institute for Geriatric Nursing has developed the newest issue of "Try This Dementia Series" in partnership with the Alzheimer's Association. "Brief Evaluation of Executive Dysfunction" supports assessment of cognitive impairment. Each "Try This" issue is a two-page document. On the first page is a description of why the topic is important when caring for older adults. On page two is an assessment tool that can be administered in 20 minutes or less.

To download this, and other "Try This" assessment tools, click here: http://www.hartfordign.org/resources/education/tryThis.html.

2004 Nurse Faculty Loan Program
Application materials are now available for the 2004 Nurse Faculty Loan Program authorized under Title VIII, Section 846A as amended by the Nurse Reinvestment Act of 2002. Only collegiate schools of nursing are eligible to apply. Application materials may be downloaded from the HRSA web site at: http://www.hrsa.gov/grants/preview/default.htm#professions.

Applicants may also request a hard copy of the application materials by contacting: Ms. Denise Thompson, Program Analyst; Phone: 1-301-443-6333; Email: dthompson@hrsa.gov. The application deadline is June 1, 2004.

HHS Awards Additional $9 Million to Help States Develop Aging and Disability Resource Centers
HHS Secretary Tommy G. Thompson announced 12 grants totaling nearly $9 million to support state efforts to create "one stop" centers to help consumers learn about and access long-term supports ranging from in-home services to nursing facility care. Visit http://www.nursingworld.org/news/ananews.htm#aging for more information.

4. HGNI People

Meet the HGNI Communications Team
Each issue of New Directions highlights a member of the HGNI Communications Working Group. This month we feature Elaine Gould, MSW, Director for Programs, Hartford Institute for Geriatric Nursing, Division of Nursing, School of Education, New York University.

Throughout her career, Ms. Gould has had a long-standing interest in continuing professional education, training, and the orientation of professionals to gerontology. Beginning in 1996, Ms. Gould assumed the position of Director for Programs, The John A. Hartford Foundation Institute for Geriatric Nursing in the Division of Nursing at New York University. Her responsibilities include overseeing all four Institute initiative areas including education, practice, research, consumer education and public policy. The Hartford Institute shapes the quality of geriatric health care by promoting the highest level of competency in the nurses who deliver that care.

Before joining the Hartford Institute, Ms. Gould was executive director of the New York Association for Ambulatory Care; project director of the Columbia University-New York Geriatric Education Center; and has presented at national gerontology-related associations. Ms. Gould earned her BA Degree at the University of Pennsylvania and her Masters Degree in Social Welfare from the Florence Heller School for Advanced Studies in Social Welfare at Brandeis University.

5. HGNI Link of the Month — The Merck Institute of Aging & Health: Nurse's Notes for Healthy Aging

The Merck Institute of Aging & Health is proud to introduce a new feature to its website, www.miahonline.org. "Nurse's Notes for Healthy Aging" is a bi-weekly article written by DeAnne Zwicker, MS, APRN, BC, a Senior Advisor for the John A. Hartford Foundation Institute for Geriatric Nursing.

"Nurse's Notes for Healthy Aging" will address common issues faced by older adults and their caregivers, including chronic pain, arthritis, over-the-counter medication issues, depression and nutrition. The consumer-focused articles will also link readers to additional online resources that are credible and accurate. The first article in the series is entitled, "Conquering Obesity: A Prescription for Health."

Write to Us

We are committed to creating a monthly publication that serves your needs and interests. New Directions, therefore, welcomes your feedback and encourages you to supply ideas, stories, resources, news and other content for subsequent issues. To make a contribution, please contact Patty Franklin at pfrankli@ana.org, Deirdre Thornlow at dthornlo@aacn.nche.edu or Elaine Gould at elaine.gould@nyu.edu.

Please Note

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