​Recent research suggests that board certification in gerontological nursing offers immense benefits for nursing facilities and residents alike. According to an analysis of U.S.-based providers conducted by AHCA/NCAL this year, facilities that employ at least one RN with ANCC board certification in gerontological nursing enjoy numerous advantages over the national average: higher five-star ratings and quality ratings, lower short-stay and long-stay rehospitalization rates, fewer deficiencies, and fewer costly immediate-jeopardy citations.

Despite the clear advantages of board-certification in gerontological nursing, however, only 1 percent of RNs have this credential. The University of Nebraska Medical Center’s Gero Nurse Prep course is designed to change this.

Developed more than a decade ago by the UNMC College of Nursing, the Gero Nurse Prep course was created to fill certain gaps in the existing standards for nursing education. “We realized that we could use our academic resources to put together an evidence-based training course that would give nurses the opportunity to learn more about the care of older adults, particularly since we knew that for many of the nurses that were practicing, elder-specific content was not addressed,” said Dr. Heidi Keeler, Director of the UNMC CON Continuing Nursing Education Office.

The course, whose development was financed by the Robert Wood Johnson Foundation, prepares nurses for the ANCC Certification Exam in Gerontological Nursing, something it’s done quite successfully since its very first graduating class in 2011. “The course was so successful—I believe it was a 100 percent pass rate for the board certification exam—that we decided to convert it to a fully online, accessible 24/7 professional development course,” Keeler said.

For many who take the course, Keeler said, the curriculum is “eye-opening.” Her team collects data about the program’s efficacy in the form of a pre-test and a post-test, with an average 20-point score differential that neatly illustrates what she hears from students firsthand: “Oh boy, there's a lot more here than just on-the-job experience can necessarily provide.” As graduates have described in surveys, they come away from the course with potentially life-saving new competencies. “We've heard all sorts of anecdotal stories about recognizing conditions and being able to act upon them, whereas before they couldn’t,” Keeler said. “We've heard of instances where nurses have actually given their administrators the book that goes along with the course and said, ‘Here, you should probably read this.’”

A Cycle of Positives

Administrators would be wise to follow their nurses’ advice. As UNMC Assistant Professor Dr. Rachel Kunkle emphasized, a nursing facility with board-certified gerontological nurses stands to enjoy significant medical and financial benefits. Kunkle would know: she was a nursing home administrator before she became a board-certified gerontological nurse.

“We know that board-certified gerontological nurses make care improvements,” Kunkle explained. “They are more equipped to educate the staff that they delegate to: the licensed practical nurses, your nursing assistants, your ancillary staff. These are nurses who can make a difference in your facility and decrease citations and decrease poor outcomes in your residents, which in turn saves you money. Administrators don't really realize that although it might seem like a big monetary investment in these nurses, you reap the benefit of increasing your care, which then increases your reputation, which then increases the amount of residents who live in your nursing home. It's kind of like this cycle of positives that can really happen.”

Certification improves more than just direct care. “Certification is all of the skills that are needed in order to provide care: the advocacy, the health promotion, the quality improvement, even knowing about the legislation and the health care policy that impacts your bottom line,” Keeler added. That said, the direct care improvements are nothing to sneeze at either. Nurses with training in gerontological care are simply better-equipped to recognize signs of decline in their residents, avoiding tragic failure-to-rescue scenarios. “What happens if the nurse doesn't recognize the signs of decline?” Keeler asked. “That person can end up sustaining lifelong injury or even die. Think of the ramifications of that happening to a facility—the cost of lawsuits, reputation, perception of care, quality relations with community and families.”

“There's a lot resting on the competency and the ability of nurses to both deliver care and have indirect care knowledge as well,” she said. “How to deal with people, how to communicate, how to plan out interventions.”

Moving from Reaction to Prevention

If the benefits of board-certification in gerontological nursing are so clear, what accounts for that tiny percentage of nurses who actually have it? In short: people just don’t know it’s an option.

“There's a lack of knowledge, in that a lot of nurses aren't aware that this is a potential step in their nursing career,” Kunkle suggested. “Certification is kind of the buzzword in those institutions that support it and bring in the resources and encourage nurses to do that, which is typically more in your acute care settings. It's not really known that there's this component in gerontologic nursing.”

Looking at the broader state of the industry, Keeler and Kunkle stressed the need for policymakers to address workforce problems and more adequately provide nursing facilities with the resources they need to care for elders. For now, though, they see the Gero Nurse Prep course as a proactive strategy to prepare caregivers for the challenges they’ll face, helping mitigate the endless cycle of reactive (and often expensive) measures to address problems that already occurred—a cycle that Keeler likened to constantly putting out fire after fire, with barely any time to spend on preventing fires in the first place.

When you get down to it, this sort of strategy is very literally in everyone’s best interests. “At the end of the day, none of us escape getting older," Keeler concluded. “If we live long enough, we may find ourselves in a nursing home situation. It would behoove us to be proactive and take care of these things now, before we’re just dealing with another fire.”

Steve Manning is a journalist based in New York City.