offer grants to nursing schools to increase the integration of geriatrics into their core curricula.

Similar initiatives have also been developed to support education and training in geropsychiatric nursing. For example, in 2007 the John A. Hartford Foundation awarded $1.2 million to establish the Geropsychiatric Nursing Collaborative. This group will establish a core set of geropsychiatric competencies in order to develop basic curricula for all levels of nurse training (The John A. Hartford Foundation, 2007).

Advanced Practice Registered Nurses

An RN may become an APRN by obtaining a master’s degree and may become certified either through a national certifying examination or through state certification mechanisms. An APRN functions as an independent health care provider, addressing the full range of a patient’s health problems and needs within an area of specialization. There are a number of different types of APRNs, including: nurse practitioners (NPs), who provide primary care; clinical nurse specialists, who typically specialize in a medical or surgical specialty; certified nurse anesthetists; and certified nurse midwives. The pipeline for producing APRNs with a specialization in geriatrics is inadequate to meet the need. As with other types of nurses, the John A. Hartford Foundation has been a key supporter in the development of the geriatric APRN workforce. In particular, the Building Academic Geriatric Nursing Capacity Scholars and Fellows Awards Program targets doctoral and post-doctoral nurses and APRNs who want to redirect their careers toward geriatrics (Fagin et al., 2006).

NPs represent a particularly important component of the workforce caring for older adults because of their ability to provide primary care as well as care for patients prior to, during, and following an acute care hospitalization and also to care for residents in institutional long-term care settings. NPs treat a disproportionate number of older adults—23 percent of office visits and 47 percent of hospital outpatient visits with NPs are made by people 65 and older (Center for Health Workforce Studies, 2005). Furthermore, NPs care for a higher proportion of elderly poor adults than do physicians or physician assistants (Cipher et al., 2006). Finally, NPs have been shown to provide high-quality care and be cost-effective (Hooker et al., 2005; Melin and Bygren, 1992; Mezey et al., 2005).

While APRNs care for large numbers of older adults in ambulatory care, hospitals, and institutional long-term care settings, APRN education programs lack specific geriatric requirements. The AACN publishes a set of competencies called Nurse Practitioner and Clinical Nurse Specialist Competencies for Older Adult Care (AACN, 2004), but it does not require



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