Job duties for geriatric nurses

mustangsheba · Dec 3, 2000

Look for the Journal of Gerontology. Geriatric nurses specialize in the unique problems of our elderly, which range from elderly patients who are competent mentally but are physically fragile to the severe disability of Alzheimer's. Geriatric nurses generally do a lot of medication management, especially assessing for side effects and toxicity related to slower metabolism. Safety, of course, is a big concern. Weakness and dizziness resulting in falls is a biggy. There are psychological and sociological problems specifically related to the elderly - loss of friends and spouses, isolation, depression. The biggest challenge is honoring the persona while addressing the deteriorating self care abilities. This is very broad. Hope it helps.

Tim-GNP · Dec 3, 2000

Gerontological nurses are a very special group of people. The knowledge base one must have to be a G.N. is quite broad. Often, nurses who commit their lives to serving the elderly are often dismissed by fellow nurses as 'burnouts' who 'couldn't handle real nursing' [i.e., acute care]. Most Gerontological nurses work in community health and long term care settings [although they are found in a plethora of other settings as well].

From someone who has done both, I can tell you-- the assessment skills you must have in order to be a successful Gerontological nurse go far beyond ordinary assessment skills. You must know first of all, what is normal, what is normal for the aging body, and then, what is pathological for the aging body. It is more complicated than it sounds. When I worked acute care, it was a piece of cake. If we weren't sure about something, we called the resident on-call... who was there in a matter of minutes. If we needed x-ray, EKG, lab, CT scan, all support services were readily available. In my setting [long term care], you had to try to figure out what each individuals norm was, and try to piece together what may be going on with the patient. This is especially important when you are calling a covering physician on a Saturday night at 10:00 p.m. who really doesn't know the patient, or wonders why you're wasting his or her time [especially when they would ask you what the patient's code status was]. More than once, I had a covering physician laugh at me and say 'well... he [or she] is a no code, what do you want me to do for him [or her]. " This is where your patient advocacy skills must come into play as you tactfully explain 'DNR' does not mean 'Do not treat.'

Many times, being a good Gerontological nurse means just being a good listener, using your psychology skills. The patient may be making multiple somatic complaints, and the more time you spend with them, the more the loneliness and depression pokes it's head through. If you take the extra 10 minutes during these times, and talk with the person.... The somatic complaints disappear.

Being a good Gerontological nurse also means being receptive to the past. Many times my patient's feel that I need to know about what life was like for them growing up. I have learned a wealth of information about what life was like growing up in the 1920's and 1930's [sometimes sooner]. One of my patients even once told me how she remembered the sinking of the titanic [she was a young girl of 12 at the time].

Being a good Gerontological nurse means not only trying to maintain health for your older adult patient, but also respecting when to let go, and helping your dying patient and their family any way you can. You help your patient by providing comfort care, and being present and helping them to maintain their dignity and you help their family by your loving support.

I have waffled on enough. I guess you can kind of tell that I love being a Gerontological nurse. You can learn much more by visiting some of the organizations I belong to, such as:

http://www.geron.org/ http://www.ngna.org/ http://www.mmhc.com/nhm/ http://www.ncgnp.org/

Also if you go to the site:

www.nursingworld.org and click on 'american nurses credentialing center' you can find the description of both a generalist Gerontological nurse and a Gerontological clinical nurse specialist and a Gerontological Nurse Practitioner [which Is what I am]. The site is very well done and should give you a ton of information!!!

I hope these help.... Good luck with your paper.

Fudo · Mar 7, 2001

Tim;

I read your post with interest. I gave an inservice on Patient Assessment just last week and I made those exact points about assessment skills and listening to your patient. Also about not mistaking DNR for Do Not Treat. Sometimes that gets me in hot water with doctors that do not want to treat DNR's. Being a strong advocate for your patient frequently means being a pain in the butt to the MD's

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The thorn defends the rose,yet it is peaceful and does not seek conflict

duckie · Mar 8, 2001

Tim, as I read your post, I thought to myself, there is nurse who knows what he is talking about!!! There is however one other issue I would like to bring up, partly to vent my feelings at this time. All fields of nursing deal with death, but in our field it is more often and usually not in a quick and dignified way. I am very thankful for the wonderful physicians I have to work with, for they truly do try to do all they can to give dignity to those who are in their final hours. I am somewhat tired and weary right now, for I have lost 6 of my residents since the beginning of this year. Only two were not expected, the rest lingered for some time, in a non-responsive state. This is very difficult to deal with at times especially when you have 2 or 3 at the same time. And that is often what we must deal with. When you are the only nurse on a unit and you have your own work load to carry, plus your heart longs to be at the bedside of someone you have grown to love as family, but you must figure out how to divide your time between everything you must do for all of your residents and also give extra consideration to those who are dying, and truthfully you usually leave feeling as though no one got enough of your time, this provides a major stress. I lost 2 residents yesterday. I have been in this field for over 20 years and I have yet to be able to go through the deaths in an unaffected way. I love my residents and I also mourne when they die, as do my wondeful staff. Our facility has a wonderful support system for anyone terminal or on comfort measures only, but thankfully we also have wonderful ministers that comfort the staff. I have noticed that death comes more frequently in certain seasons, so I actually plan my vacations around when I feel the worst is over, just so I can renew myself to go through the next season. Perhaps I am burned out but I cannot even think of changing fields, for I truly love what I do and the people I care for. I'm trying to get tough but it usually doesn't work, so I just come home, cry till my tears are gone, then I go in the next day to hold more hands and do the best I can. For anyone who believes what geriatric nurses do is not real nursing, I challenge you to work in LTC for a couple of months, then tell me you didn't use all the skills you were taught and then some. I could never do what hospital nurses do, and I admire them greatly. Isn't it wonderful we are all different and can all make such a difference to the lives we touch. What it boils down to is that we are all very special and we do matter and make a big difference everyday to those we care for. Every field of Nursing offers challenges but they also have their rewards. One of the things that made me decide to stay in geriatrics is that I love listening to their stories and hearing about history first hand, from those who have lived it. And though it often makes me weary, I want to be there to hold their hand when they leave this world, for I want them to know, they are loved. Sorry I have rambled on, as I said, I am weary right now, but I will continue what I do, for it is in my heart. And Tim, I can tell you are a great nurse, your residents are blessed!

destiny5255 · Apr 8, 2001

Originally posted by Tim-GNP:
Gerontological nurses are a very special group of people. The knowledge base one must have to be a G.N. is quite broad. Often, nurses who commit their lives to serving the elderly are often dismissed by fellow nurses as 'burnouts' who 'couldn't handle real nursing' [i.e., acute care]. Most Gerontological nurses work in community health and long term care settings [although they are found in a plethora of other settings as well].

From someone who has done both, I can tell you-- the assessment skills you must have in order to be a successful Gerontological nurse go far beyond ordinary assessment skills. You must know first of all, what is normal, what is normal for the aging body, and then, what is pathological for the aging body. It is more complicated than it sounds. When I worked acute care, it was a piece of cake. If we weren't sure about something, we called the resident on-call... who was there in a matter of minutes. If we needed x-ray, EKG, lab, CT scan, all support services were readily available. In my setting [long term care], you had to try to figure out what each individuals norm was, and try to piece together what may be going on with the patient. This is especially important when you are calling a covering physician on a Saturday night at 10:00 p.m. who really doesn't know the patient, or wonders why you're wasting his or her time [especially when they would ask you what the patient's code status was]. More than once, I had a covering physician laugh at me and say 'well... he [or she] is a no code, what do you want me to do for him [or her]. " This is where your patient advocacy skills must come into play as you tactfully explain 'DNR' does not mean 'Do not treat.'

Many times, being a good Gerontological nurse means just being a good listener, using your psychology skills. The patient may be making multiple somatic complaints, and the more time you spend with them, the more the loneliness and depression pokes it's head through. If you take the extra 10 minutes during these times, and talk with the person.... The somatic complaints disappear.

Being a good Gerontological nurse also means being receptive to the past. Many times my patient's feel that I need to know about what life was like for them growing up. I have learned a wealth of information about what life was like growing up in the 1920's and 1930's [sometimes sooner]. One of my patients even once told me how she remembered the sinking of the titanic [she was a young girl of 12 at the time].

Being a good Gerontological nurse means not only trying to maintain health for your older adult patient, but also respecting when to let go, and helping your dying patient and their family any way you can. You help your patient by providing comfort care, and being present and helping them to maintain their dignity and you help their family by your loving support.

I have waffled on enough. I guess you can kind of tell that I love being a Gerontological nurse. You can learn much more by visiting some of the organizations I belong to, such as:
http://www.geron.org/ http://www.ngna.org/ http://www.mmhc.com/nhm/ http://www.ncgnp.org/

Also if you go to the site:
www.nursingworld.org and click on 'american nurses credentialing center' you can find the description of both a generalist Gerontological nurse and a Gerontological clinical nurse specialist and a Gerontological Nurse Practitioner [which Is what I am]. The site is very well done and should give you a ton of information!!!

I hope these help.... Good luck with your paper.

HI TIM,

I am a LPN at a LTC facility and II don't believe I could have said or put it any better

than you did ,very well said. I believe as you said one of the major areas that a geria-

tric nurse has to know is how to be a good listener as well as very, very observant

as well . And knowing that each pt is totally different from the last one is another concern. As far as trying to stay unattached it is somewhat better now but when i

started in LTC facilities I can't tell you how many times I lost a pt and went home

for hours and cried and kept wandering what else I could have done.Now it still

hurts but I understand a little better than I did than.Gerontalogy is all I know basically

(have had other positions) but my calling is the elderly,NOT because I got burnout

but mainly because of my precious grandmother who has long gone now but she

was the one who wanted to become a nurse and to specialize in the elderly.She

seemed to believe I had a gift for it, well after all I was her only granddaughter.But

she was right about one thing I do love working with the elderly--its a lot of hard work

sometimes unpleasant work but can also be very, very REWARDING.

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destiny5255