4:15am! That’s what time it was when I was sitting in Vancouver’s CBC Radio studios waiting for my moment on The Current with Anna Maria Tremonti. It was an amazing experience and I’m grateful for the graciousness of the CBC staffers who were there to help me through it.
I was on for less than 5 minutes and I had SO MUCH TO SAY. So what better place to say it than in a GERO blog? So here’s what AMT missed (and I’m always happy to go back on the show to say it there!):
I have been working in and observing Seniors Care in Canada for the past 20 years. What have I learned? You can throw money at as many boutique programs and sparkly international consultants as you like, but without a strong foundation we will never get anywhere. And what’s at the foundation of healthcare? Registered Nurses. So until the majority of the 200,000+ RNs working in acute care, home care, and residential long-term care can identify delirium in an individual with dementia we aren’t going to get anywhere. Until the Emergency Nurses (who I’m sure all identify as ER nurses) also realize that 44% of the patient presenting to them are Seniors, and that infection presents differently this population so there may not be the classic signs like fever, we aren’t getting anywhere.
Because nurses are the front-line. We are the ones holding the door open to the healthcare system and are there every.minute.of.the.day.and.the.night. If a nurse can’t identify a delirium then it’s not going to be reported to the physician and the wheels aren’t going to start turning to resolve it. I could go on here about the costs of delirium to the individual patient and to the healthcare system but I think I covered that on The Current (it’s a bit of a blur).
Solutions? I have one that my 20 years of practice, research and administrative work have led me to: education. This may seem obvious, but here’s the nub: Seniors Care is as invisible in nursing education as it is in healthcare. I would bet dollars to donuts (that’s a saying, right?) that every nursing program in Canada has a pediatric and a maternity nursing course. Does every program have a course on nursing care of older adults (aka gerontological nursing)? No. Shocking, right? Our programs are supposed to reflect the needs of the Canadian population but we continue to ignore the largest group receiving healthcare services. Students who are graduating are more likely to know the stages of labour than the stages of Alzheimer’s Disease (and I am not knocking maternity courses here, just making a point).
And then it goes downhill when you get into practice. Want continuing education on how to be a critical care nurse? Check. Operating room nurse? Check. ICU Nurse? Check. Emergency Nurse? Check. Gerontological Nurse? Silence. Guess what though? We are almost at a point where the majority of patients cared for by critical care, operating room, ICU and emergency nurses are Seniors.
There are best practices in education about nursing care of older adults. But we need to commit to them. We need our accrediting body to hold undergraduate programs to account for how they are preparing the next generation of nurses to meet the needs of older Canadians. We need educational leaders to provide professional development for faculty in this area and to ensure that gerontological nursing is placed later in programs so that students can appreciate the complexity of this specialty. We need employers to support and offer continuing education opportunities for nurses in practice (self-endorsement here: check out the Geriatric Education & Training Program for Acute Care Nursing on UBC’s open access portal).
Nurses can transform Seniors Care. But we all need to be educated about it first.