1. Integration of Geriatric Curriculum Content into a Synergy Model Driven Acute Care NP Program
BMcLear, DNP, FNP-C, ACNP-BC
Georgia Regents University
College of Nursing

2. GRU Acute Care Nurse Practitioner Program
History
2010-HRSA grant awarded
First DNP ACNP program in the Southeast
2011 Program for Accelerated Certification Education (PACE-ACNP)
Mastering Essentials by Gaining Awareness during immersion days (MEGA i days)

3. The APRN Consensus Model
Licensure -granting of authority to practice.
Accreditation -formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing- related programs.
Certification - formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession.
Education -formal preparation of APRNs in graduate degree-granting or post-graduate certificate programs
The consensus model was designed to align the inter-relationships among licensure, accreditation, certification, and education to create a more uniform practice across the country. We anticipate that the consistency – and clarity – that results from the new model will take advanced practice nursing to the next level, benefiting individual nurses and enhancing patient care.
The consensus model is the product of a collaborative effort among more than 40 organizations (including ANCC) that have an interest in making the practice more uniform.
ANCC is leading the way to ensure that this transformative model will enhance the certification process. APRNs, educators, and collaborative organizations should turn to ANCC for the most up-to-date information regarding the consensus model's effects on certification.
Full implementation of the consensus model will require coordination groups that represent licensure, accreditation, certification, and education. We expect full implementation of the consensus model to be complete by 2015.
Impact of the Consensus Model on Certification
As implementation of the new consensus model progresses, ANCC's certification programs may change to more closely reflect the roles and populations required in the model. To help APRNs make the transition as smoothly as possible, ANCC will provide advance notice and information on the effects of any required changes.
In the Consensus Model for APRN Regulation1, patient safety is a key uniting link among the
components of advanced practice registered nursing (APRN) regulation – licensure,
accreditation, certification, and education (LACE). Nurse practitioners (NPs), as the largest
group of APRNs, have a prominent role in addressing patient health care needs in the current
and evolving US health system. The alignment of the LACE components defines the NP scope
of practice with a goal of public protection. 2 As described by the Pew Health Professions
Commission, scope of practice is the “definition of the rules, the regulations, and the boundaries
within which a fully qualified practitioner with substantial and appropriate training, knowledge,
and experience may practice.”3 As part of an ongoing commitment to advance patient safety
and clarify scope of practice, this paper elaborates on a significant issue for NP practice: The
distinctions and overlap in practice by acute and primary care NPs.
NCSBN, 2008

5. Primary Care NP roles
Primary Care Education:
Focus on comprehensive chronic, continuous care characterized by a long term relationship between the patient and NP.
Cares for patients with a focus on disease prevention, assessment and management of common acute and chronic illnesses.
Populations:
Pediatric
Adult Gerontological
Family
NONPF, 2011

6. Acute Care NP roles
Acute Care Education:
Focus on restorative care that is characterized by rapidly changing clinical conditions.
Care for patients with unstable chronic conditions, complex acute illnesses, and critical illnesses
Populations:
Pediatric
Adult Gerontological
NONPF, 2011

7. AACN Synergy Model AACN,2015
The core concept of the reconceptualized model of certified practice — the AACN Synergy Model for Patient Care — is that the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses. Synergy results when the needs and characteristics of a patient, clinical unit or system are matched with a nurse's competencies.
AACN,2015

8. Patient Characteristics
Outcomes
Nurse Competencies
Patient Characteristics
Resiliency
Vulnerability
Stability
Complexity
Resources
Participation in care
Participation in decision making
Predictability
Nurse Competencies
Clinical Judgement
Advocacy and Moral Agency
Caring Practices
Collaboration
Systems Thinking
Response to Diversity
Facilitation of Learning
Clinical Inquiry

9. Patient Characteristic
Nurse Competency
Course
Stability
Clinical Judgement
Level 5 - Highly stable
Constant
Responsive to therapies
Low risk of death
Level 1
Collects basic-level data
Follows protocols
Questions the limits of one's ability
Delegates the decision-making
AGACNP I
Level 3 - Moderately stable
Maintains steady state for limited time Some responsiveness to therapies
Level 3
Collects and interprets complex patient data
Makes clinical judgments based on an immediate grasp of the whole picture
Recognizes patterns and trends
Recognizes limits and seeks appropriate help
AGACNP II
Level 1 - Minimally stable
Labile
Unstable
Unresponsive to therapies
High risk of death
Level 5
Synthesizes and interprets multiple sources of data
Uses past experiences to anticipate problems
Helps patient and family see the "big picture“
Recognizes the limits of clinical judgement
Seeks multidisciplinary collaboration
AGACNP III &
AGACNP practicum
Assesses individuals with complex health issues and co-morbidities, including the interaction with aging and acute and chronic physical
and mental health problems

10. Why a geriatric focus?
Inpatients over the age of 65 years of age 38.7%(2010)
Average length of stay days
Percent of adult day services center participants: 63.5% (2012)
Percent of home health agency patients: 82.4% (2011)
Percent of hospice patients: 94.5% (2011)
Percent of nursing home residents : 85.1% (2012)
Percent of residential care community residents: 93.3% (2012)
Avg length of stay younger age groups
CDC, 2010
CDC, 2013

11. UAB Faculty Scholars Program
Offered by UAB Geriatric Education Center
1) advanced illness and palliative care
2) transitions in care
3) family systems and self/caregiver management
4) communication skills addressing the cultural aspects of aging and health literacy

12. UAB Faculty Scholars Program
160 hours of training
5 in person sessions
2 day Interdisciplinary geriatric education conference
12 Continuing education modules
1 Scholarly activity-publishable article or grant
1 Curriculum enhancement activity

13. Resource Availability
Vulnerability
Overview of Aging
Low vision and aging: an interdisciplinary approach
Incontinence
Resource Availability
SNF, ALF, SCALF, IL, LTC – What Does It All Mean
Preventing Elder Investment Fraud
Medicare Overview
Complexity
Complex Decision Making
Advanced Care Planning
Family systems
Medication Management
ResiliencyThe capacity to return to a restorative level of functioning using compensatory/coping mechanisms; the ability to bounce back quickly after an insult
VulnerabilitySusceptibility to actual or potential stressors that may adversely affect patient outcomes
ComplexityThe intricate entanglement of two or more systems (e.g., body, family, therapies)
Resource availabilityExtent of resources (e.g., technical, fiscal, personal, psychological and social) the patient/family/community bring to the situation
Participation in careExtent to which patient/family engages in aspects of care
Participation in decision-makingExtent to which patient/family engages in decision-making

14. Advocacy Moral agency Caring Practices Collaboration
Health Disparities and Aging
Ethics and Aging
Caring Practices
Developing Empathy
Geriatrics for Hospice and Palliative Care Workers
Collaboration
Geriatric Interdisciplinary Team Training
Inter-professional Competencies
Advocacy and Moral AgencyWorking on another's behalf and representing the concerns of the patient/family and nursing staff; serving as a moral agent in identifying and helping to resolve ethical and clinical concerns within and outside the clinical setting

15. Gerontology Day
“Unless someone like you cares a whole awful lot, Nothing is going to get better. It's not.”

16. An Aging Society
For the first time in history, people aged 65 and over will soon outnumber children under the age of 5.
Throughout the world today, there are more people aged 65 and older than the entire populations of Russia, Japan, France, Germany and Australia— combined.
By 2050, the U.N. estimates that the proportion of the world's population age 65 and over will more than double, from 7.6% today to 16.2%.
The United States contains more people age 65 and older than the total population of Canada.
Americans aged 65 and older outnumber the combined populations of New York, London, and Moscow.

18. Objective Structured Clinical Exam (OSCE)
Focus on:
Uncommon presentations of common illness
Polypharmacy
Mobility

19. Geriatric Immersion Experience

20. References
Center for Disease Control(CDC),2010. Older Adult Health,National Hospital Discharge Survey. Accessed
Center for Disease Control(CDC),2013. Older Adult Health,Long term health services overview. Accessed
National Council for State Boards of Nursing(NCSBN),2008.Consensus Model for APRN Regulation: Licensure, Accreditation, Certification and Education. Accessed resources/APRNReport.pdf
National Organization of Nurse Practitioner Faculties(NONPF), Statement on Acute Care and Primary Care Nurse Practitioner Practice. Accessed