New Tool to Assess Nurse Skills in Caring for Older Adults Will Help Hospitals Ensure Skilled Workforce

The John A. Hartford Institute for Geriatric Nursing at NYU College of Nursing this month released a significant tool for evaluating the competency of nurses caring for hospitalized older adults. The assessment instrument, Geriatric Competencies for RNs in Hospitals, was published in the January/February 2006 issue of Journal for Nurses in Staff Development.

“As hospitals prepare to care for increasing numbers of older patients, the Geriatric Competencies will be a highly useful tool to orient new nurses, teach hospital policies and procedures, or review skills for more experienced nurses,” says co-author Mathy Mezey, EdD, RN, FAAN, co-director of the Hartford Institute for Geriatric Nursing.

The development of the Geriatric Competencies emerged from a growing recognition that the checklists used by many hospitals to assess nurses’ competence in taking care of older adults patients differed widely among hospitals. The new Geriatric Competencies help hospitals establish and assess the minimum competencies that the average bedside nurse should have mastered in caring for older patients. There are competencies in eight categories of crucial knowledge: Communication (including the ability to discuss advance directives and other legal issues with patients and their families); Physiological and psychological changes in older adults; Pain, particularly among patients with dementia; Skin integrity; Functional status; Urinary incontinence; Nutrition and hydration; Elder abuse; and Discharge planning.

“Hospitals can tailor these competencies to their own needs,” says co-author Eileen Quinlan, MSN, APRN-BC, a geriatric nurse practitioner and coordinator of the Geriatric Competencies project at the Hartford Institute. “The article in this month’s Journal for Nurses in Staff Development helps hospitals consider how they might want to evaluate nurses in these skills.” She adds that nurses might not be expected to master all of the competencies in their first year on the job, but these skills should be considered goals for attainment within several years.

The Hartford Institute was particularly interested in pain and how it can be assessed and treated among patients with dementia in acute-care settings. “In most cases, pain is no different in an older patient than in a younger one, but if the patient has dementia, the nurse cannot assess it in the same way. A patient might demonstrate pain through anxiety, agitation, or refusal to eat, for example,” says Dr. Mezey. “Nurses need to understand how to assess and manage that pain, as well as to understand older people’s risk for other issues such as falls and urinary incontinence.”

In 2004, the competencies were tested at Mount Sinai Medical Center’s Morchand Center. Nationally recognized for its work with standardized patients, the Morchand Center recruits actors who, using a script, are trained to realistically simulate the signs and symptoms of a disease or patient condition and to provide feedback regarding participants’ performance. Simulations are conducted using rooms configured as outpatient offices and hospital rooms. Participants can be observed through a one-way mirror and interactions can be recorded (

Fourteen nurses volunteered to be tested on two competencies: urinary incontinence and fall-risk assessment. An actress played an older woman who had gone to the emergency room after a fall. The nurses under observation were tested in their ability to assess the reason for her fall, her urinary incontinence and their ability to move her from a wheelchair to bed. Of the nurses tested, those who had received earlier training in geriatric care scored higher on the competencies.

“I never anticipated what a valuable tool the Geriatric Competencies would be,” says Ms. Quinlan. “They can help individual nurses validate their expertise as well as recognize and rectify gaps in their knowledge. And they can help hospitals ensure a nurse workforce knowledgeable in geriatric care.”

Geriatric Competencies for RNS in Hospitals appears in Journal for Nurses in Staff Development, January/February 2006. Authors: Mathy Mezey, EdD, RN, FAAN; Eileen Quinlan, MSN, APRN-BC, Susan Fairchild, MPH, Maria Vezina, EdD, RN.

The John A. Hartford Foundation Institute for Geriatric Nursing seeks to shape the quality of health care that older Americans receive by promoting the highest level of geriatric competency in all nurses who deliver care. By raising the standards of nursing care, the Hartford Institute aims to ensure that people age in comfort and dignity. Its initiatives include education, practice, research, policy, and consumer education.

The College of Nursing at the College of Dentistry is located on New York University’s historic Greenwich Village campus in New York City. The College of Nursing is one of the leading nursing programs in the United States. The College offers a Bachelor of Science in Nursing; Master of Arts and Post-Master’s Certificate Programs; and a Doctor of Philosophy in Research Theory and Development. For more information, visit

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