As Population Ages, Hospital Nurses Increasingly Finding their NICHE

By Chris Lund

People over the age of 65 are expected to grow from 13.3% of the US population today to 20.3% by 2030, and those over the age of 85 are projected to increase from 5.7 million in 2011 to 8.9 million people in 2030. As the population ages, it will become increasingly important for those in the medical profession to be adept at caring for older patients, who utilize a disproportionately large segment of healthcare services. Indeed, despite comprising only 13% of the population today, the CDC estimates that those over the age of 65 accounted for 39% of hospital discharges in 2010.

ElderBranch previously discussed the major shortage of geriatricians the US is facing as this “silver tsunami” approaches. What is less well-known, however, is that there is also a major shortage of nurses that lack expertise in caring for the elderly. According to The American Geriatrics Society, less than 1% of registered nurses (RNs) and less than 3% of Nurse Practitioners are certified in geriatrics.

According to Catherine Roscoe-Herbert, DNP, APRN, FGNLA, the NICHE Coordinator at University Hospitals Health Systems in northeastern Ohio, “we respect the notion that older adults present with specific and atypical needs. Given the volume of older adults we serve, it behooves us to have specialized care providers in terms of a nursing staff sensitive to the needs of older adults.” With few nurses receiving this specialized training in their baccalaureate programs, hospitals are left to find geriatric educational resources for their nursing staff after nurses have already entered the workforce.

Nurses Improving Care for Healthsystem Elders (NICHE)

Based at New York University’s College of Nursing, the Nurses Improving Care for Healthsystem Elders (NICHE) program’s vision is sensitive and exemplary care for all patients 65-and-over. To accomplish this goal, NICHE provides interested hospitals with state-of-the-art training, tools, and resources to educate nurses and to stimulate a change in the culture of healthcare facilities to achieve patient-centered care for older adults.

NICHE traces its roots back to 1981 when the Geriatric Resource Nurse (GRN) Model for improving the geriatric knowledge and expertise of the bedside nurse was initiated at Boston’s Beth Israel Hospital. The GRN Model prepares staff nurses to identify and address specific geriatric syndromes, such as falls and confusion, and to implement care strategies that discourage the use of restrictive devices and promote patient mobility. Upon completion of the program, nurses can apply for certification in geriatrics.

Given the lack of in-depth training most nurses have in the care of older adults, the NICHE Program is an evidence-based resource for hospitals endeavoring to improve the care of its patients in a clinically appropriate and cost-effective manner. Flora Haus MSN, RN-BC, the NICHE Coordinator at Cedars-Sinai Medical Center in Los Angeles, says “We recognize that as good stewards in healthcare, our organization strives to move forward with relevant education for staff so we can care for the changing face of our patients. The NICHE organization, as a robust evidence-based organization, was almost a no-brainer. We need to be efficient as well as effective and not reinvent the wheel [in educating our nurses].”

As explained by Linda Bub, the Education and Program Development Director at NICHE, the benefits for hospitals and their nurses extend beyond just the formal educational resources. “NICHE-designated hospitals also join a community of other leaders that can help improve care without needing to have a geriatric nurse expert on staff at the hospital.” Indeed, NICHE facilities form a cooperative community, which allows for the sharing of best-practices in caring for older adults through the use of discussion boards, webinars, and conferences. For a small annual fee, hospitals receive access to all of these resources, which have the potential to lead to transformational improvements in the care of geriatric patients.

NICHE Training Improves Geriatric Care

The NICHE Program is quite popular with nurses nationwide. At Cedars-Sinai, “nurses have come out of the woodwork to tell me, ‘how do I learn more?’ NICHE education has been totally voluntary, yet nurses have overwhelmingly beaten the bushes down to get to me because they want to use it,” according to Flora Haus. Catherine Roscoe-Herbert has found a similar reaction at University Hospitals: “Initially, I focused on just the geriatric program. I sought out to identify 25-30 nurses strategically planted throughout the hospital to go through the training. But the need was so great, and the interest was so high, I have trained close to 400 nurses through NICHE.”

As NICHE-designated hospitals provide access to nurses with educational materials through NICHE, hospitals have seen improved clinical outcomes, positive financial results, enhanced nursing competencies, and greater patient, family, and staff satisfaction. According to Ms. Herbert, at University Hospitals, “we prevent falls, we treat dehydration and incontinence right away which can help prevent delirium, and we have been able to reduce the average length of stay of patients…Nurses are identifying geriatric syndromes sooner as a result of their NICHE training, which creates positive outcomes for patients. Furthermore, nurses have indicated a greater knowledge base for the work that they do, and thus they have found greater work satisfaction.”

While these results are certainly good news for hospital management teams, the better news is for geriatric patients who are now receiving care from nurses who feel confident in their ability to provide high quality care.

A Large and Growing Presence in Hospitals Nationwide

With obvious benefits to patients, nurses, and hospitals, NICHE is being adopted at an accelerating rate nationwide. The program has grown to include almost 500 hospitals and other healthcare facilities throughout North America, with over 80 new facilities achieving NICHE-designation in the last year.

While slightly less than 10% of hospitals nationwide have achieved NICHE-designation to-date, it is perhaps no surprise that 28 of the US News & World Report’s Top 50 Hospitals for Geriatric Care, including both Cedars-Sinai Medical Center and University Hospitals Case Medical Center, are members of the NICHE Program. These NICHE-designated facilities have demonstrated organizational commitment and continued progress in improving quality and enhancing the patient and family experience for geriatric patients.

As the population continues to age, the need for nurses specially trained in geriatric syndromes will become even more imperative. With a robust and growing educational platform, NICHE is well-positioned to provide the training, resources, and community support necessary for hospitals to meet NICHE’s vision of providing all patients 65-and-over with “sensitive and exemplary care.”

> Find a NICHE-designated facility near you

Nurses Improving the Care of the Healthsystem Elders (NICHE) is an Atlantic grantee via New York University College of Nursing.