Article Archive
January/February 2020

Nursing: The Gero Nurse Prep Program
By Kathy Hardy
Today’s Geriatric Medicine
Vol. 13 No. 1 P. 32

As the population of older adults continues to rise, increased training in gerontological nursing is a vital step in providing the proper care and value to residents of skilled nursing and long term care facilities. The American Health Care Association/National Center for Assisted Living (AHCA/NCAL) Gero Nurse Prep program leading to the American Nurses Credentialing Center (ANCC) board certification exam is an educational option designed to help meet the changing needs of individualized care for the older adult population.

The AHCA/NCAL Gero Nurse Prep is an online education program that prepares RNs who care for older adults to take the ANCC board certification exam in gerontological nursing and also increases their knowledge of, and ability to provide, evidence-based gerontological nursing practice.

“The benefits of gerontological nursing training are endless,” says Heidi Keeler, PhD, RN, an assistant professor at the University of Nebraska Medical Center’s (UNMC) College of Nursing — Omaha Division and director of continuing nursing education. “We know from our course evaluations that nurses not only increase their knowledge base but also leave the course feeling more confident in their knowledge and skills in caring for older adults.”

The Gero Nurse Prep program began as a Robert Wood Johnson grant–funded project, led by two UNMC faculty members, and Keeler explains that UNMC has remained involved with the program.

A Timely Effort
Dave Kyllo, vice president of insurance and member programs for AHCA, also speaks to the increased security in knowledge gained by nurses in geriatric practice as they complete training and board certification testing.

“Working with the elderly population requires a specialized knowledge base, particularly in dealing with the variety of specialists involved in patient care, such as physicians, physician assistants, and nurses, Kyllo says. “You need to have confidence in your knowledge of geriatric medicine, to have an understanding of what’s happening with your patients, and to have meaningful cross-functional discussions with a multidisciplinary care team.”

Board certification can also help geriatric care nurses keep abreast of the needs of a growing aging population. According to the US Census Bureau, for the first time in the country’s history, the population of adults aged 65 and older is projected to outnumber that of children younger than age 18 by 2034. The difference in the two demographic groups is expected to increase over time, with 94.7 million older adults in 2060, compared with 80.1 million children. With this projected growth, 23.4% of the US population in 2060 is projected to be individuals age 65 and older.

“While there is a general understanding of the gerontology specialty,” Kyllo says, “many nurses may only have minimal training in geriatrics. Geriatric medicine is more advanced today than it was in the ’70s or ’80s, and today, nurses need the knowledge-based credential that the Gero Nurse Prep program and board certification can bring them.”

Consumer expectations are greater today in geriatrics than they were earlier, Kyllo adds. In previous years, an older adult could fall and break a hip; the hip would be pinned, and the patient would be bedridden. “Today, when a geriatric patient breaks a hip, the first question they have is, ‘How soon will I be back doing the activities I was doing before I broke my hip?’ There’s an expectation that the injury is just a temporary setback, not a permanent situation.

“With that,” Kyllo continues, “facilities are looking to board-certified nurses as a means of improving patient care. In that light, certification gives nurses an edge in the professional marketplace.”

Evolution of the Program
As Keeler explains, Gero Nurse Prep started as a blended live/online program based in Omaha, in collaboration with a prominent senior living services provider. As the program took off, the decision was made to transition to an online course available to all nurses across the country. In 2011, the course was redesigned to fit this format, and has been retooled and updated multiple times based on new clinical and policy-related material and learner feedback since its launch.

“The program was started to address the quality of nursing care within the older adult population,” Keeler says. “The long term care environment was a focus, since national priorities also concentrated on this setting. The course was specifically designed as an academic offering for nurses to ensure high quality and expertise. The idea of extending the course outcome to board certification preparation was added to ensure that the nurses’ hard work would result in a tangible result, symbolizing the nurses’—and their facility’s—commitment to quality nursing care.”

Test result statistics demonstrate the program’s success, Keeler says, with an average 24-point difference in pre- and postcourse test scores. In traditional academic terms, she equates this to the difference between earning a grade of D and a grade of A. In addition, Gero Nurse Prep program graduates see a 96% first-try pass rate on the ANCC board certification exam, as compared with a general national pass rate of about 75%.

The current version of the course, mapped to the ANCC test outline, consists of 10 online education modules that cover topics such as “Wellness and Aging Statistics,” “Comprehensive Assessment,” “Pharmacology,” and “End of Life.” In addition, the course also includes milestones that prepare participants for registering for and completing the board certification exam. Keeler says the self-paced program was created for completion in 30 hours, based on the pace of the average learner, and can be accessed from any location 24/7 to accommodate working RNs on various work schedules.

“The course is designed by faculty and practice experts, so it includes best practice care standards,” Keeler says. “In addition, the course was designed with the ANCC board certification examination outline content in mind, to ensure that the content reflected this gold standard of nursing specialty expertise.”

While there are no prerequisites for taking the program, Keeler recommends that nurses review the ANCC eligibility testing requirements. Those criteria state that a nurse seeking certification in gerontology must have a current RN license from a US state or territory, have completed two years in full-time practice as an RN, have at least 2,000 hours of gerontological nursing practice over the past three years, and have completed 30 hours of continuing education in gerontological nursing within the last three years; successful completion of the Gero Nurse Prep program fulfills the final requirement.

Keeler adds that the program is designed for RNs, but they do not need to have earned a BSN to participate. In addition, RNs from all areas of practice, not just in the long term care industry, are able to participate and can benefit from the program in many ways. The Gero Nurse Prep content covers all elder care settings, as does the ANCC Board Certification exam.

Getting Involved
Kyllo says that taking the Gero Nurse Prep course does not obligate RNs to take the ANCC Board certification exam. Registered nurses who are interested in increasing their knowledge of gerontological nursing practice can simply complete the course, receive 30 nursing contact hours, and increase their skills and knowledge of geriatric nursing.

The ANCC Gerontological Nursing Board certification examination is a competency-based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of RNs in the gerontological specialty after initial RN licensure. Upon completion of eligibility requirements to take the certification examination and a passing score on the exam, RNs receive the RN-BC credential: registered nurse-board certified. This credential is valid for five years.

“The AHCA partnered with UNMC after the Gero Nurse Prep Program was started,” Kyllo says. “We saw how well the program prepared nurses for board certification and thought it would be a good idea to work together in an effort to further educate nurses in the gerontology specialty.”

According to the AHCA/NCAL website, facilities with at least one RN on staff with ANCC Board Certification in gerontological nursing have significantly better outcomes in key areas on which nursing facilities are judged. For example, employing board-certified nurses can help facilities increase their standing in the Centers for Medicare & Medicaid Services (CMS) Five-Star Quality Rating System, with such facilities twice as likely to receive a five-star distinction.

“Facilities also see improved CMS and state department of health survey results when they have certified geriatric nurses on staff,” Kyllo says, “with a reduction in the average number of deficiencies. Fewer deficiencies are better for residents and facilities.”

Geriatric nursing training is also important as payment systems change to a value-based scenario in health care, Kyllo says, particularly with regard to rehospitalizations. The skilled nursing facility value-based purchasing program awards incentive payments to facilities based on their performance on the program’s measure of readmissions.

“With new payment systems now, the CMS score is used to determine how much is returned based on rehospitalization rates,” Kyllo says. “Therefore, there’s a financial incentive to lower rehospitalizations.”

Another benefit of geriatric nurse training, he says, is that it may result in a lower use of off-label antipsychotics, which are often prescribed for nursing home residents with dementia, a disease that affects approximately 40% to 60% of all nursing home residents. Recent research and evidence question the effectiveness of prescribing atypical antipsychotic medications for dementia as a means of modifying behavior. Antipsychotic drugs are expensive and can increase risks of death, falls with fractures, and hospitalizations of long term care residents. Kyllo says it has been a goal of the long term care industry for the past several years to safely reduce the off-label use of antipsychotics. Training in geriatric nursing covers alternative strategies for responding to challenging behavioral expressions in persons living with dementia.

“Buildings with board-certified geriatric nurses use fewer antipsychotics,” he says. “Training in geriatric nursing makes a difference.”

While RNs in general are trained to provide the best care possible for their patients, geriatric nurses learn the specifics of providing specialized care for older adults and helping them with issues such as maintaining their mobility, independence, and quality of life. They are trained to anticipate the needs of aging adults and work closely with primary care physicians, attending physicians, social workers, and family members to help provide individualized care.

Leaders in the field believe that with the Gero Nurse Prep program and board certification, skilled nursing and long term care facilities benefit by having happier residents and families, which leads to more referrals and lower turnover rates and helps facilities stand out among the community.

— Kathy Hardy is a freelance writer based in Phoenixville, Pennsylvania.