With about 26 percent of all LPNs working in nursing homes, LPNs are especially important to the care of older adults in long-term care settings (BLS, 2007b). LPNs often provide more hours of care per nursing home resident per day than do RNs (Harrington et al., 2006). LPNs receive about 1 year of training through technical or vocational schools or through junior or community colleges. With experience and training, LPNs may supervise nurse aides. For example, the Institute for the Future of Aging Services is developing a leadership training program to teach LVNs the necessary skills and competencies to be more effective supervisors (IFAS, 2008). Some of the elements of this training include communication, critical thinking, conflict resolution, and cultural competency. Little is known about the geriatric training of LPNs.

Registered Nurses

As with other professions, nurses generally receive little or no preparation in the principles that underlie geriatric nursing in their basic nursing education. In 2005, 31 percent of new RNs received baccalaureate degrees, but only one-third of the baccalaureate programs required a course focused on geriatrics. Almost all baccalaureate programs include some geriatric content, but the extent of this content is unknown (Berman et al., 2005). While 42 percent of RNs receive their initial education through associate degree nursing programs (HRSA, 2006b), the degree of integration of geriatrics into these programs is also unknown. Given the paucity of geriatric content in programs preparing nurses, it is appropriate to assume that most practicing RNs have little formal preparation in geriatrics.

There exist a number of efforts aimed at ensuring nursing competency in geriatric care. In 2000, for example, the American Association of Colleges of Nursing (AACN) developed guidelines for geriatric competencies in baccalaureate programs. The National Council of State Boards of Nursing (NCSBN) mapped those guidelines against the National Council Licensure Examination (NCLEX), which is required for licensure of all nurses, to ensure adequate testing on geriatric issues (Wendt, 2003). Still, more needs to be done to analyze the depth of this content (Bednash et al., 2003).

As with other professions, there exist various public and private efforts aimed at increasing the geriatric content of nursing programs and developing geriatric nursing leaders. Since 1996 the John A. Hartford Foundation has invested $60 million in the Hartford Geriatric Nursing Initiative, which includes the Institute for Geriatric Nursing and the Centers of Geriatric Nursing Excellence. These programs foster the development of academic leaders and increase geriatric content in the education and training of nurses. In 2002 the Atlantic Philanthropies funded a 5-year initiative to improve nursing competence in treating older adults (Box 4-1). Under the



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