As a highly specialized skill set, nursing is in high demand. As such, nurses can make a lucrative career by their full-time work alone, and by supplementing it with a variety of nursing side hustles. For those entrepreneurial spirits, there is seemingly no limit to the possibilities.
Home Health Care
There are certain areas of nursing where per diem work is more abundant. Many specialties within the hospital, such as critical care, emergency, surgery, and telemetry, require specific skill sets that the only nurses who fill in are already trained in that specialty. This is because per diem work comes with the expectation that minimal training is required.
There are however, some areas where skills do translate from one area of nursing to another. This is especially true outside the hospital. For example, adult inpatient nurses can work as a home infusion nurse, or in other home health care work, such as overseeing ancillary nursing staff, doing intensive assessments, and advocating for patients with their providers and insurance carriers.
Home health care is a growing field of opportunity as it benefits the patient by allowing them to maintain quality of life in their home; it can also help reduce the logistical strains on the health care system to provide inpatient care.
Aesthetic Nursing
For nurses with an eye for beauty, aesthetic nursing offers a wealth of opportunities. As technology advances, there are more and more non-surgical procedures with anti-aging and aesthetic benefits. Nurses are increasingly able to perform or assist physicians with such procedures in medical spas and dermatology clinics. Furthermore, often this work is available as part-time or per diem. This allows nurses to build up a clientele through a side hustle that works with their schedule and is generally high-paying. Qualifications and credentialing for work as an aesthetic nurse vary by location, but frequently nurses go through certification programs in order to attract employers for this type of work.
Teaching
Working as adjunct faculty is the side hustle of the teaching world. Many nursing schools offer opportunities to instruct a limited number of courses per semester on a part-time basis. This allows nurses with specialized knowledge or skills to disseminate what they know to the next generation of nurses. There are opportunities for both online and classroom teaching today. Requisites for teaching vary by state, school, and specific courses. For example, many nursing schools require five years of experience in a given specialty or an advanced degree in nursing, in order to teach.
Coaching
Coaching is another growing field for nurses. For coaches who are nurses, they mostly function as health coaches or career coaches to other nurses. In the former role, nurses work with clients to mobilize them in the direction of their own personal and health goals. This is done through motivational interviewing, establishing accountability, goal-setting, and most of all-empowering the client to be experts on their own lives and bodies.
This role does not involve medical oversight and instead draws on the nursing skill of patient education combined with the holistic approach to patients that is fundamental to nursing. Nurse career coaches are often experienced and successful nurses who have built lucrative and fulfilling careers in nursing and coach other nurses or aspiring nurses to do the same.
Legal Nurse Consultants
Legal nurse consultants (LNCs) serve as expert nurses that work in medical-legal matters. LNCs are usually experienced nurses that can address technical matters specific to nursing, which a layperson may not know. They may work in law offices, HMOs, hospitals, risk management, workers’ compensation, and so on.
The legal nurse consultant utilizes their clinical and logistical expertise to extrapolate or clarify matters related to medical-legal cases. There are many full-time legal nurse consultants but it is incredibly valuable as a side hustle because it allows the nurse the opportunity to simultaneously work clinically, honing expertise and skills, while contributing the value of such real-time experience to their work in legal matters.
Nursing is a growing field for many reasons, not the least of which is that it offers a multitude of avenues by which to obtain a high income and a fulfilling career. For the nurse who wants to branch out beyond what they specialize in full time, there is certainly no lack of side hustles in nursing for them to explore.
One of the best ways to find out what a nurse’s day is really like is to shadow a nurse for the day. Whether you are a nursing student, a new nurse, or a nurse with many years of experience, job shadowing someone before you venture into a specific arm of nursing is a smart career move.
Kathy Quan, RN, BSN, PHN, author of The Everything New Nurse Book, and founder of The Nursing Site, says she thinks shadowing is particularly important for home health nurses and those considering something like hospice nursing.
“I loved the home health rotation in college,” says Quan. “You have that one-on-one with patients that you don’t get in the hospital. You can spend that time with the family and with the patient.” And although that one-on-one time is what Quan wanted to have, a more experienced nurse explained the reality of home health to her so she could understand the big picture and what the job really required. “She said, ‘If you want this for a Monday to Friday, 8 to 5 job, this probably shouldn’t be your primary goal.’”
Home health jobs, Quan learned, are really 24/7, because of the very relationship you build with the patient. If a patient needs you or has special needs that you don’t want to hand over to someone else, you need to be available, she says. You also need to be able to let some responsibility fall to a patient. “You have to have faith that they can do this,” Quan says. For instance, you have to trust they will take their medication and keep an eye on an IV if needed.
And, surprisingly, the amount of paperwork for home health is greater than it is in a hospital, says Quan. If that’s not something you think you could keep up with, it’s certainly good to know before you look for a job in the field. When you shadow someone for a day, whether as a home health nurse, in a hospital, or in the field, you’ll have a concrete understanding of what their tasks are.
Shadowing a nurse also gives you an incredible perspective that you would never get from a job interview process. For instance, if the paperwork seems endless at first, it helps to know how another nurse handles it. For Quan, seeing how the paperwork in home health care is built around the nursing process made it easier for her. “It is a lot, but after you get used to it, it’s old hat,” says Quan.
And hospice nurses use their nursing skills in a way that is different from something a nurse in a cardiac unit might do. There is an intimacy to discussing and helping with end-of-life care for patients. If you are considering hospice nursing, you would benefit greatly from shadowing a hospice nurse for a couple of days. By doing so, you can see how nurses engage with patients and families and use their nursing skills for comfort. You will be able to gauge if that’s something you could and would want to do full time.
The extra time spent job shadowing a nurse can help point you down the right career path.
New York City’s museums are some of the most well known, distinctive, and influential in the world. Now, they’re commemorating the life and influence of the “mother of public health nursing,” Lillian Wald, as well as the organization she founded, the Visiting Nurse Service of New York, the largest nonprofit home health care organization in the United States.
This past summer, the Museum of the City of New York added a permanent display in its new Puffin Foundation Gallery for Social Activism documenting Wald’s life and the 119-year history of the VNSNY. The display is a part of the Activist New York exhibition and was assembled with help from current VNSNY staff. Open every day from 10:00 a.m.–6:00 p.m., the museum can be found at 1220 Fifth Avenue, New York, New York.
VNSNY staff also worked with the Yeshiva University Museum in its exhibition “Trail of the Magic Bullet: The Jewish Encounter with Modern Medicine, 1860 to 1960.” Though that show concluded in August 2012, visitors can still explore other exhibits at the museum, open Sunday through Friday, located at 15 West 16th Street, New York, New York.
After spending four decades climbing the stairs of New York City’s tenement apartments to deliver compassionate, expert home care to hundreds of Spanish-speaking patients in the South Bronx, Washington Heights, and other communities, Elsie Soto, R.N., a veteran public health nurse at Visiting Nurse Service of New York, may be forgiven for enjoying 2011 as the year she became something of a nurse “celebrity.”
In recognition of contributions made during her lifelong career in home care nursing, Elsie was named “Clinician of the Year” nationwide by the Visiting Nurse Associations of America, an award presented at VNAA’s annual meeting in Baltimore, Maryland, in April. In May, Elsie was honored by the Home Care Association of New York State with a prestigious statewide “Caring Award,” for which all Empire State professionals, paraprofessionals, and family caregivers are eligible. This award goes to one “who has exhibited the compassion, skills, and service that set their contribution apart, or whose actions on a particular day, or over a period of time, exemplify outstanding compassion,” according to the award website. Rounding out a trifecta of recognition, Elsie was also recognized by NursingSpectrum magazine with a 2011 “Excellence in Nursing Award” as a regional finalist in community service.
“I want to thank my familia at VNSNY—including many coworkers, past and present—and my patients for allowing me to enter their homes and do my magic,” Elsie said in her acceptance speech. “In my life, I’ve always been surrounded and guided by three important and influential women: mi mami Elena for caring, Florence Nightingale for commitment, and VNSNY founder Lillian D. Wald for service.” Elsie also acknowledged her fivebrothers “who were [her] first patients,” her husband and children, and the early support received from a priest and nun (“long before the word ‘mentor’ became popular”) who encouraged her to pursue a career in nursing, even though it took Elsie away from Catholic high school in the Bronx.
“Mi casa es tu casa“
Bilingual in Spanish and of Puerto Rican heritage, Elsie has long played a leadership role in providing culturally sensitive care to VNSNY’s Latino patients in NYC—a population that in sheer numbers is second only to Los Angeles among Spanish-speaking communities nationwide. In addition to the exceptional care Elsie has provided most recently in the predominantly Dominican neighborhood of Washington Heights, she also serves among VNSNY’s key representatives in the New York chapter of the National Association of Hispanic Nurses. Several years ago, when NAHN honored VNSNY with an “Institutional Award” for the agency’s efforts to “raise awareness of health care disparities and increase diversity in nursing practice,” Elsie was asked to personally accept it.
Elsie is no stranger to accolades and recognition. In 1993 and again in 2008, Elsie was nominated by VNSNY colleagues and went on to win ESPRIT Awards, the organization’s highest honor. (ESPRIT Awards are named for VNSNY’s values: Excellence, Service to Customers, People, Fiscal Responsibility, and Teamwork.)Elsie and her patients were also the focus of a 2007 cover story in ADVANCE for Nursesmagazine entitled “Mi Casa Es Tu Casa: Culturally Sensitive Home Care for Hispanics at VNSNY.” She has also been featured in news articles about VNSNY’s agency’s longest-serving veteran nurses.
Since joining VNSNY as a 20-year-old LPN, Elsie has striven to stay as “flexible as a willow,” relying on a sense of humor to help patients through the tough times. Colleagues cite her stellar commitment to patient care and praise her willingness to always go above and beyond.When nominating Elsie for an ESPRIT award, one coworker wrote, “Elsie is knowledgeable regarding all dimensions of her patients’ conditions, including both clinical and social aspects.”
Elsie shares a memorable patient story from her vast trove: “I was asked to pre-pour meds and informed that my patient’s front door would be open. It was evening when I arrived. To my dismay I found the patient waiting for me in the dark. I immediately turned the lights on. Finally, sitting down to pre-pour his meds, I realized that he was blind. I apologized for not being mindful. He started to laugh, and told me stories of others who had been guilty of the same ‘crime.'”
Elsie still remembers one of her very first home care patients, “Anna,” who lived alone in the South Bronx back in the 1970s. For more than nine months, Elsie provided daily care for Anna’s breast cancer wound. As a new nurse, Elsie remembered feeling silently skeptical when Anna said the wound would heal. Eventually, it did heal, and Elsie recalled feeling a mixture of joy and sadness when she said goodbye to Anna on her final visit.
In addition to using her prized bilingual ability in Spanish to care for VNSNY’s huge numbers of Hispanic/Latino patients, Elsie has also provided home care to patients in many other immigrant communities in New York City, one of the world’s most diverse megacities. From caring for culture-shocked Vietnamese refugees in the Bronx in the wake of the Vietnam War to Russian, Chinese, East Indian, Pakistani, and patients from other ethnic groups, Elsie has personally carried on the mission of VNSNY: “caring for all New Yorkers.” In an example of such service, in the aftermath of Hurricane Katrina in 2005, Elsie was one of fewer than 50 VNSNY nurses to be recognized for aiding Katrina evacuees at Disaster Assistance and Welcome Centers set up by the New York City Department of Health.
Today the nation’s largest nonprofit home health care organization, VNSNY was founded in 1893 by Lillian Wald, the “mother of public health nursing,” to serve the teeming immigrant population of New York City in the 19th century. Through the work of clinicians like Elsie and some 2,600 other nurses on staff, the agency has continued this role into the 21st century.
“The Bronx is burning!”
New York City is home to the nation’s second-largest Latino community, comprised of Spanish-speaking peoples from more than 20 nations. Collectively, they comprise more than a quarter of the city’s population, according to the U.S. Census Bureau. By contrast, Elsie is among a small minority—one of the estimated 2% of U.S. nurses who speak Spanish—and among approximately 4,500 Spanish-speaking nurses serving an estimated 2.5 million Latino residents of New York City. Elsie’s role as a coordinator of care and public health nurse has kept her on the front lines at VNSNY, which employs New York City’s largest pool of Spanish-speaking health care providers.
Born to parents who immigrated to New York City from Moca, a town in the mountains of Puerto Rico, Elsie is the only girl in a family with five younger brothers. They grew up in the South Bronx. During this period, the borough was plagued by crime, drugs, and frequent arson fires. “The Bronx is burning,” the saying went. Elsie credits her parents and Catholic schoolteachers with providing a bulwark against the devastation and modeling responsibility to one’s community.
Elsie became an LPN through a program at Jane Addams Vocational High School and then went on to become a registered nurse at Bronx Community College in 1974 (later pursuing B.S.N. studies at Mercy College). She became involved in home care early and worked in her own neighborhood for 14 years. The needs in this area were especially great in the 1970s and 1980s. Elsie recalls a litany of problems with “riots, job losses, crime, decay, drugs.”
“I personally witnessed the arrival of heroin in the Bronx and watched how it decimated people in droves,” she says. For two years in the mid-1980s, Elsie’s treatment area included the Webster Projects, scene of the highest homicide rate in New York City, with approximately one killing per week. Elsie personally cared for one of the four young men shot in 1984 by notorious “Subway Vigilante” Bernhard Goetz. She recalls needing security escorts on nearly every visit in those days.
Being a Spanish-speaking Latina is an asset in her community, Elsie says, “because even though they know I’m not Dominican, or Cuban, or Mexican, I do speak the language. We have that basic cultural identity. Automatically things are clearer and more relaxed and they think ‘you may not be of my origin, but you speak my language.'” As in any culture, nonverbal communication in the Hispanic culture is as crucial as verbal communication.
These days, with a caseload of about 15 patients a week, Elsie serves patients in mostly Dominican neighborhoods of Washington Heights in upper Manhattan. Although Elsie essentially shares the same language as her predominantly Hispanic patients, she expresses appreciation for the subtle and not-so-subtle differences among various communities. Elsie notes that Hispanics are defined as “persons of Mexican, Puerto Rican, Cuban, Central or South American, or other Spanish cultures.” The term Latino encompasses Brazilian, Asian, and African cultures as well.
“We may share the same town name (there is a Moca in the Dominican Republic too) and ways of connecting,” Elsie says, “but we’re diverse. That’s what makes us so unique. Because of my accent, Dominican, Cuban, and Mexican patients will know that I am from Puerto Rico, but we’re all connected. I try as much as I can to learn about their culture from them and to let them learn from me.”
La familia and culturally sensitive care
Elsie notes that to deliver culturally sensitive care, home care nurses must be mindful of the importance of la familia in Hispanic culture. “You have to include the family as part of the healing process,” she says. “Whoever it is—abuela (grandmother), aunt, godmother—you have to incorporate them because they have wisdom to offer, and so that you can be successful.” She adds that religious and cultural beliefs also play important roles in caring for the Hispanic patient. Many believe pain is an expected part of life and a consequence of immorality.
Elsie Soto with fellow ESPRIT winners in 2008
“Some people will say ‘I’ll take the pain because this is part of my punishment,’ and coming from the Hispanic culture, I can identify with the idea of paying for something I did wrong years ago,” Elsie says. “You have to give respect to the notion of pain as a punishment from God. I tell patients that I understand, but I think you have been forgiven, and now I am here because God is telling me to facilitate your pain and let you go more peacefully.”
On a daily basis, Elsie deals with the fact that Hispanic Americans suffer one of the highest rates of diabetes in the United States, with a prevalence that is more than 50% greater than among average New Yorkers. “As a Hispanic, I implement this knowledge that we have in my work at VNSNY—and on a personal level, I share that my mother and father died very young and that diet plays a role in their heart disease and diabetes,” Elsie says. “But I’m also flexible and do not completely try to demoralize my patients because it’s not going to work,” she adds. “I try to modify the diet but not completely take away their food.” Elsie is drafting a Spanish-language publication on this topic for the Alzheimer’s Association of New York.
Eight years ago, Elsie was one among a small group of VNSNY staff who joined together to revive the dormant local chapter of NAHN, founded in 1975 and committed to improving the health of Hispanic patients and communities and increasing educational, professional, and economic opportunities for Hispanic nurses. Thanks to such efforts, the NAHN chapter is vital once again.
Elsie is involved in a pilot program called the Hispanic Leadership Project, to develop such skills among Hispanic nurses. Elsie notes that the project sprang from a yearlong nursing course called the Minority Leadership Program that she took some years ago at Rutgers University. Elsie also attends NAHN’s national conventions. In summer 2009, she presented a poster on diabetes and comorbidities among Hispanic patients at NAHN’s annual meeting in San Antonio, Texas. She and others presented on the pilot Hispanic Leadership Project.
“Home care has been my ‘second home’—an amazing journey for me,” Elsie says, when asked how her profession and role as a home care nurse has changed in the past 40 years. “The fundamental care of nursing has not changed. What has changed is the introduction of technology in the home and in our manner of communicating. My journey has been filled with much love for the work I perform and the people I work with…”
Talk about a momentous birthday—the oldest baby boomers started celebrating their 65th birthdays in 2011, ushering in what appears to be a huge change in health care demands in the United States. As the population ages in unprecedented numbers and is living longer than at any other time in history, the field of gerontological nursing is facing big changes with staffing needs and day-to-day practices.
Experts in gerontological nursing are reporting a greater demand for nurses now and in the future. As the number of patients increases, a sufficient number of nurses will be needed to care for them and to relieve the workload. The solution is complex and depends on the collaborative actions of government agencies, health care providers, colleges and universities, and nurses themselves.
According to a 2005 report by the National Institute on Aging and the U.S. Census Bureau, projections indicate that by 2030 the older population will total 72 million residents, doubling the number from the year 2000. By that time, one in five citizens will be 65 or older. And, according to the report, seniors are living longer lives, but 80% of them have at least one chronic health condition (such as heart disease, diabetes, or respiratory problems) and half of them have at least two. So even as the population enjoys living longer, the health care needs of older adults are more complicated.
“There is a strong assessment that the current workforce today is not prepared to care for the population,” says Amy Cotton, M.S.N., G.N.P.-B.C., F.N.P.-B.C., F.N.G.N.A., and president of the National Gerontological Nursing Association. “Another issue of great concern for colleges is when graduates are not prepared to care for the population they have to care for, it creates a lot of job stress and can lead to a lot of turnover.”
Typically, health needs become more complex as people live longer lives. There is a pressing need for competencies surrounding normal aging, cultural norms, and the very fine line of effective communication with the patient. And as the age gap between the younger workforce and the increasingly older patient gets wider, awareness of those variations is essential to provide good care.
“Those generational differences can create a schism,” says Valerie Kaplan, Ph.D., A.R.N.P., F.N.P.-B.C., F.A.A.N.P. and a senior policy fellow with the American Nurses Association. For instance, older generations grew up following a doctor’s orders with no questions asked. Younger generations—who often search for second opinions and cutting-edge treatments—might find that a puzzling way to approach personal health.
In addition to the age differences, census predictions indicate that the population will be composed of more ethnically diverse elders by 2030, with 72% being non-Hispanic white, 11% Hispanic, 10% African American, and 5% Asian. “There is a diversity explosion in growth for various ethnic groups in this country,” Cotton says.
As those populations age, there arises a pressing need for more diversity among nurses. Cultural awareness of family expectations, patient lifestyle, and cultural norms often gives the nursing staff an indication of how to proceed with care plans. The more a nurse knows about a patient, the more likely the care plan will be successful from the beginning.
Natalie Nieves, a case manager for VNA Health Care of Hartford in Connecticut, sees firsthand the need for nurses of all backgrounds. “Minorities can be majorities in the inner cities,” she says. “Being bilingual is a plus in my field. [Patients] trust you a lot more, and they confide in you a lot more.”
When a Spanish-speaking patient can speak with a nurse also fluent in that language, they glean more from the conversation, since the details do not get lost in translation. “There is no barrier,” Nieves says. “It is clear, concise, and direct. It is amazing the difference it makes.” As valuable as an interpreter is, having a relationship where both parties speak the same language just makes it easier. “When a nurse goes out with an interpreter,” says Nieves, “the patient feels like they are talking to two people at once.”
The elderly patient benefits are both emotional and physical when they are receiving health care from a bilingual nurse. “There has to be an understanding of how cultural norms impact decisions,” says Tara Cortes, Ph.D., R.N., F.A.A.N., Executive Director of The Hartford Institute for Geriatric Nursing and professor at New York University’s College of Nursing. For instance, Nieves, who is of Hispanic descent and fluent in Spanish, has noticed this in her own practice when she visits patients who might not relate how a diet full of foods traditional to his or her upbringing might impact something like blood sugar levels.
“We need to encourage minorities to nursing,” says Nieves. “We need them out there.”
For most nurses working with an older population, good communication is of primary importance. “If you can’t, at a basic level, communicate with an older adult, you will miss the boat when caring for that adult,” Cotton says. “That communication is a critical piece and a basic piece that is easily missed. We have such a hurry-up system.”
Sabina Ellentuck, who is launching a second career as a nurse, says she tries to take a breath and focus on the patients before she approaches them. In a way, quieting her own thoughts helps her slow down, greet her patient, find out how they are doing, and speak with them for a while before moving on to the health care procedures. “You have to be able to connect with them or they will not listen or do what you ask,” she says.
That bit of personal interaction also gives a valuable perspective. “It is feeling good and communicating and having fun with them,” says Ellentuck. “On top of which there is this big need.”
Most nurses, whether or not they work primarily with a geriatric population, will care for elderly patients at some point in their careers; knowing the normal signs of aging is an essential skill. “You have to think of what aging does to vision and hearing,” says Cotton. There can be changes in balance, memory, or mobility. Personal interactions and communication also allow nurses to glean an understanding of what is a normal result of aging and what might be a red flag for something more serious.
But nurses feel the time crunch. “There is pressure to do things quick, but it is extremely important to connect with the patient and be a good detective and pick up signs when something is wrong,” Ellentuck says. “It is hard to do that when you are rushed. The balance really is the challenge of integrating good health care while doing all these things.”
While the need for nurses continues to grow, pay disparity is often a roadblock, says Cotton. When nurses can earn more money in an acute care setting than in a long-term facility setting, they are generally drawn to the higher pay scale. Cotton says payment reform has to occur to attract more nurses to the field. After all, many nursing students graduate shouldering large debts, and paying them off is of primary importance. “It is hard to support yourself with what a geriatric nurse makes today,” says Cortes.
Many experts say the foundation for successful gerontology nursing practices begins in school and continues as nurses enter the workforce.
“The first exposures to gerontological nursing practices are critical,” says Cotton at the National Gerontological Nursing Association. Students need exposure to healthy, vibrant elders, as well as those who are sick or frail. And age does not always indicate health. Students need to be able to refute the myth that aging goes hand-in-hand with illness. “Changing that perception requires interaction with healthy and well elders,” says Cotton.
Valerie Cotter, D.N.P., A.N.P./G.N.P.-B.C., F.A.A.N.P., and advanced senior lecturer and Director of the Adult Health Nurse Practitioner Program at the University of Pennsylvania School of Nursing, says schools are trying to make it interesting for students to come into the field of geriatric nursing. One of the best ways for that to happen is for students to see the passion that so many professionals have for working with an older population. Describing that job satisfaction to students is essential, Cotter says, especially if the students have not had an opportunity to experience in their own lives.
“I was fortunate to have a good relationship with my grandparents,” says Cotter. “As a nurse, I gravitated to older adults. I love the life story and the narratives. Older adults have many more experiences, and you look at health within the context of those life experiences.” Through education as well as their personal experiences, nurses are able to sharpen their skills to the complex needs of the elderly and recognize red flags quickly. “You have to know the baseline status to recognize change,” says Cotter.
In 2002, according to an article in Health Affairs, 58% of baccalaureate nursing programs had no full-time faculty with specializations in geriatrics.1 “We still don’t have enough geriatric content built into the undergraduate curriculum,” says Cortes. “We need nurse practitioners for geriatric care. We do not have enough physicians to care for this population. Nurses can do a tremendous job of keeping the older population safe and at home and functioning at their highest level.”
Even a nurse who works in ICU needs to know if the patient has had a flu shot to provide comprehensive care. A nurse might encounter a healthy and active 90 year old or 67 year old with high blood pressure, complications from diabetes, or other serious health issues. “The reality is we are still providing care for adults across the continuum,” says Kaplan. “As they age, their health care needs are not driven by where they end up in the health care facility, but by the health care problems. [Nurses] need to identify the care needs of patients not based on where they work.”
While an important foundation of geriatrics is educational, Kaplan says, nurses need a general understanding of what it is to care for someone who has lived through different times. “The brain changes are sometimes more challenging than the physical changes,” Kaplan says. They are also more difficult for some family members to come to terms with. The nurse’s job, says Kaplan, is to be present for the patient. “If they are in 1945, then you are in 1945,” she says. “It is important that nurses as caregivers recognize that and not challenge that.”
Nieves says there is so much going on with an elderly patient that nurses are forced to use all their nursing skills on the job. “You use every single thing you have got,” she says. “I really truly enjoy my job.”
The industry is constantly developing models for consistent, coordinated, and collaborative care for older adults, says Cortes, but it is the nursing staff that carries it out. Nurses care for the whole person, she says. Caring for an elderly population is much more complex than treating only health issues. With elderly patients, you must consider their lifestyle. Are they eating enough? If not, is that because they forget or because they do not have enough access to food or transportation to get food? Do they have a small appetite? Is their medication impacted in any way by their foods? Are they taking their medication exactly as prescribed? How involved is the family, and how will family beliefs and attitudes change the course of the care?
To encourage nurses to specialize in geriatrics, it’s important to get nurses into the field and show them how rewarding it can be. “I’d love to see the number of nurses certified in geriatric nursing and practicing as NPs, and caring for elder adults increase,” says Cortes. “Nurses will be much more involved in developing those practices. It is very positive.”
Ellentuck finds the changes galvanizing. “It is a very exciting time now in how we think of helping older adults—many assumptions no longer exist,” she says. “A prime focus now is on function and getting people moving, moving out of those wheelchairs (if possible), doing activities that connect to the person’s interest or background. . . . To me, this is very exciting, and I look forward to being involved and doing these new practices that are truly patient-centered care.”
Reference
Christine Tassone Kovner, Mathy Mezey, and Charlene Harrington, “Who Cares for Older Adults? Workforce Implications of an Aging Society,” Health Affairs 21 (2002): doi: 10.1377/hlthaff.21.5.78.
