An Alternative Solution to Our Shortage of Nurses, Physicians, Pharmacists, and Other Health Care Providers?
Article Outline
Dr. Barbara Resnick
We have begun to recognize that the problem of shortages can’t easily be solved by increasing the number of students we have in any of these professions, although that is a critical building block. In schools of nursing, we have more than manageable numbers of students interested in nursing; we simply don’t have the faculty or resources to teach all of them. We increasingly are recognizing and acknowledging the critical need to educate all health care providers with expertise in geriatrics. This point was reflected nicely by Chad Boult in the New Yorker article by Atul Gawande, “The Way We Age Now.”2 This has been the focus of many of the programs supported by the Hartford Foundation and the increase in geriatric content across schools of nursing and other disciplines. Slowly and steadily geriatric content is being introduced either in special electives for students, required coursework, or integrated in to prior course content.
I would propose another solution that I believe we need to work toward. That solution involves embracing interdisciplinary care for older adults. This interdisciplinary model needs to be supported through policy initiatives and in the education and training of our health care providers in care of older adults. Interdisciplinary care is defined as “a plurality of disciplines where disciplinary boundaries are often muted and the joint contributions of the synergy are highlighted.”3 As noted by Kenneth F. Ferraro,3 interdisciplinary work implies an integrated approach. This is in contrast to multidisciplinary work that entails collaboration among investigators from more than 1 discipline. In multidisciplinary work, disciplinary boundaries are maintained and the unique contributions of each are highlighted. Consideration of how we define our disciplines with regard to geriatric care help to demonstrate why I believe interdisciplinary can help contribute to the solution for managing health care needs of older adults in the future.
The Geriatric Focused Philosophy in Each Discipline
Geriatricians are defined as physicians who are board certified in family practice or internal medicine before completing additional training in geriatrics. Geriatric medicine provides the most comprehensive health care for the most vulnerable seniors. By promoting wellness and preventive care and helping to improve patients’ overall quality of life by, it allows them greater independence and prevents unnecessary and costly institutional care.1
A geriatric nurse practitioner (GNP) is a registered nurse with a master’s degree from a nurse practitioner program specializing in the care of older adults. GNPs are educated to diagnose and manage acute and chronic diseases and take a holistic approach to meet the medical, psychosocial, and functional needs of older persons. A major goal of the National Conference of Gerontological Nurse Practitioners4 is to advocate quality care for older adults.4 Similarly, the National Gerontological Nurses Association5 describes their core purpose as improving the quality of nursing care given to older adults.
The Geriatric Social Work Initiative,6 which is focused on preparing social workers for an aging population, describes aging focused social worker as “navigators” and “expediters,” enabling older adults and families to understand and choose among the bewildering array of available health and social services. These social workers empower older adults and families to find appropriate services. They also facilitate family support, provide counseling and direct services, and coordinate care delivered through professional services.
The Association of Physical Therapy7 has a special section focused on geriatric physical therapy. The purpose of this section is to further the physical therapists’ ability to advocate and provide best practice physical therapy for optimal aging. The vision they share is that the physical therapist will be the practitioner of choice for achieving optimal health, wellness, fitness, and physical function for the aging adult. Their goals focus on respecting the uniqueness and diversity of aging adults through compassion, caring, commitment and excellence in the provision of services.
Senior care pharmacists8 are described as specialists in geriatric drug therapy and the unique medication-related needs of seniors. As such they identify and prevent medication-related problems through careful evaluation and monitoring of patients’ drug regimens.
Clearly the goals and agendas of each of these disciplines are quite similar. That being said, we each are likely to engage in activities and provide services to older individuals that cross the boundaries of what the other disciplines might be equally capable of doing. There are times when the physician may be best at providing the service, and at other times the nurse, nurse practitioner, physical therapist, pharmacist, or social worker may be the best choice. Depending on the clinical situation, several of these individuals are likely to have the skills and ability to help the older individual make an informed decision about care. Policy that acknowledges this is critical. In the state of Maryland, for example, there is an advanced directive form for the emergency medical providers and hospital emergency staff that must be signed by the physician. It is not situation-specific, and the discussion with the older individual has generally occurred with a nurse, nurse practitioner, or social worker. The use of health care dollars for a patient to make an appointment with a physician to get this form signed and the time for a physician to repeat the discussion is unnecessary. The physicians’ time could be better spent in more complex diagnostic activities.
So, yes, we have a shortage of health care providers interested and skilled in caring for older adults. In response, we are trying a multitude of interventions to increase the numbers of individuals who choose to focus on care of the older adult. We are increasingly recognizing the need to teach all providers the skills required to provide care to older adults. In addition, I suggest that we not forget that we can and must apply interdisciplinary care to these individuals. We are united in focus and philosophy, and we must trust that there are sufficient older individuals who will require our services. As we begin a new academic year, let us consider how to teach our nursing students about the other disciplines and use every opportunity to teach the other disciplines about nursing. Invite your physician, physical therapy, social work, pharmacy, dentistry, and law (and others available) faculty and students into your classrooms and clinical sites. In so doing, I believe we will begin to better understand how our knowledge and expertise may overlap and how we can trust each other and better integrate care. By doing this, we will be able to provide optimal care to all older Americans by being more efficient and less duplicative.
References
- Lincoln’s Geriatric Care Act. Available at: www.lincoln.senate.gov/∼lincoln/releases/03/02/2003228A26.html. Cited May 2007.
- Gawande A. The way we age now. New Yorker. Available at: www.newyorker.com/reporting/2007/04/30/070430fa_fact_gawande?printable=true. Cited May 2007.
- Ferraro KF, Chan S. Is gerontology a multidisciplinary or interdisciplinary field of study: Evidence from scholarly affiliations and educational programming. In KF Ferraro, editor. Gerontology: perspectives and issues. 2nd ed. New York: Springer Publishing.
- The National Conference of Gerontological Nurse Practitioners. Available at: www.ncgnp.org. Cited May 2007.
- The National Gerontological Nurses Association. Available at: www.ngna.org. Cited May 2007.
- The Geriatric Social Work Initiative. Available at: www.gswi.org. Cited May 2007.
- The geriatric section of the Association of Physical Therapy. Available at: www.geriatricspt.org. Cited May 2007.
- Senior Care Pharmacists. Available at: www.seniorcarepharmacist.com. Cited May 2007.
PII: S0197-4572(07)00167-X
doi:10.1016/j.gerinurse.2007.06.002
© 2007 Mosby, Inc. All rights reserved.
