ONE OF OUR OWN IS THE FIRST NURSE

TO RECEIVE THE CLINICIAN OF THE YEAR

AWARD FROM AMERICAN GERIATRICS

SOCIETY: VALISA SAUNDERS, MN,FAAN, APRN, GNP

The American Geriatrics Society Clinician of theYear Award recognizes the importance of geriatricclinicians and the tremendous contributions theymake in providing quality health care for older adults.Through their efforts, scientific advances are inte-grated into the practice of geriatric medicine, improv-ing the well-being and quality of life of older people.Each year this award goes to a practitioner whosedevotion to patients and to the advancement of qual-ity geriatric care is nothing short of remarkable. Theclinician of the year award goes to Valisa Saunders.

Valisa Saunders, a longtime member of NCGNP, is acertified gerontological nurse practitioner with KaiserPermanente Hawaii. Ms. Saunders has won numerousawards for clinical excellence, including the 2004 Na-tional conference of gerontological nurse practitioners’award for excellence in clinical practice. Saunders is afrequent lecturer and preceptor for University of Hawaiiand has presented more than 100 talks to many othernursing and gerontological groups in her state and at thenational level.

In her 22 years of work with Kaiser PermanenteHawaii, she helped pioneer the role of the geriatricnurse practitioner (GNP) in Hawaii through her effortsto develop enabling regulations for advanced practiceregistered nurses, blending leadership and clinical rolesand her work with students from the University ofHawaii. In 1986, she helped Kaiser Hawaii launch theMedicare Risk contract clinical program, which in-cludes screening for high-risk elderly, a case manage-ment program, hospital discharge planning using nurses(for the first time), interdisciplinary geriatric assess-ment, a home health service, and nurse-managed footclinics. She later helped develop a multidisciplinary di-abetic limb clinic, was the Hawaii principal investigatorfor a Kaiser 6-region “post-diagnosis, Dementia” re-search program, and managed an outside contract toprovide neighbor island elderly geriatric assessmentclinics for Native Hawaiians with geriatric nurse prac-titioners. Her greatest legacy may have been in theestablishment and development of the standard-settingnursing home rounding program in Hawaii. Before theadvent of the program, which officially started in 1991,a shortfall of physicians doing rounds in Hawaii nursinghomes meant that many residents were not seen in atimely manner. The Kaiser Permanente Hawaii round-

ing program brought Kaiser nurse practitioners into

Geriatric Nursing, Volu248

non-Kaiser Hawaii nursing homes to do rounds for thefirst time. The team-rounding concept began with Valisain one nursing home in 1988. Now NPs and physiciansfrom several organizations on Oahu make rounds inabout 20 Hawaii nursing homes serving roughly 1000older people. The program has resulted in a decline inemergency department visits and hospitalizationsamong residents of these nursing homes as well asbetter quality care.

An expert in state and federal regulations govern-ing NPs, Saunders also helped spearhead the KaiserGeriatric Primary Care interdisciplinary program inHonolulu, which sees complex geriatric patients in itsclinics and in care homes, foster homes, and hospice.She is also an expert in psychological disordersamong the elderly and the author of a chapter on thatsubject in the text The Nurse Practitioner in Long

Term Care: Guidelines for Clinical Practice.

MJ Henderson, APRN, BC, GNP, Barbara Resnick,PhD, CRNP, FAAN, FAANP, and Warren Wong, MDnominated Ms. Saunders for this award and werethrilled to see her graciously receive it among 100s ofphysicians and nurse colleagues in Washington, DC,at the 2008 American Geriatrics Society Conference.Kudos to Valisa, and keep up the good work!

0197-4572/08/$ - see front matter

© 2008 Mosby, Inc. All rights reserved.

doi:10.1016/j.gerinurse.2008.06.011

NCGNP PIONEER IN ACUTE CARE AND

STANDARDS OF PRACTICEKathleen Fletcher, RN, MSN, APRN-BC,

GNP, FAAN

After graduating from Pennsylvania State Univer-sity in 1971, I worked at a number of teaching hospi-tals in Philadelphia.

I had been working as a nursing supervisor inmedical surgical nursing in 1978 when I married andmoved to Prescott, Arizona. I took a position at theVeterans Administration Medical Center (VAMC), andafter 10 years in nursing, I was surprised at how muchI loved working with older veterans and decided thenI wanted to be a gerontological nurse practitioner(GNP). I realized that I had seen a great deal ofageism in my 10 years of nursing and that I had beenguilty of some of it myself. I was intent on learningmore after seeing the compassion, skill, and auton-omy of the nurse practitioners in the VAMC. At the time,

there were only a few GNP programs in the country,

me 29, Number 4

and we relocated so I could attend the University ofLowell federally funded program. Laurie Kennedy Ma-lone was one of my classmates [*see GN edition].

On completion of the GNP program in 1982, I ac-cepted my first position in advanced practice at aVAMC in Pennsylvania, and after a few years I waspromoted to the position of associate chief nurse forextended care. In 1986, we relocated to Charlottes-ville, Virginia, for my husband to complete his PhD inEnglish, and I started on faculty at the University ofVirginia. Always committed to maintaining an activepractice, I set up a clinic in low-income housing forthe elderly where I would see patients and also pro-vide clinical experiences for undergraduate nursingstudent. In 1994, I was recruited to the medical centerat the University of Virginia (UVA) to focus on acutecare of the elderly. At that time, older adults com-prised 30% of the patient population at the UVA Med-ical Center (UVAMC). Recognizing the need to ad-dress the unique needs of hospitalized elderly, thechief nursing officer applied to be a participant in anew project, NICHE (Nurses Improving Care toHealth System for the Elderly) supported by the ge-riatric initiatives of the Hartford Foundation throughNew York University. UVA was 1 of 4 hospitals ac-cepted to be a dissemination site for NICHE, and itafforded us the opportunity to work closely with andbe mentored by nurse leaders Drs. Mathy Mezey andTerry Fulmer.

The acutely ill older population at UVA had grownto a staggering 45% by 2004 and continues to growtoday. To care for the older adults at UVAMC, about60 specially trained geriatric registered nurses servepatients in both the inpatient and outpatient areas.UVA has the longest sustained NICHE project, whichnow includes an acute care of the elderly (ACE) unitand a geriatric consultation service. Both are servedby an interdisciplinary team led by NPs with geriatricexpertise. As director of senior services, I also over-see the work of three GNPs working with UVA pa-tients in local long-term care facilities where theyprovide evaluation and management of patients, ed-ucate the staff, and serve on quality committees in the4 long-term care facilities in which they work. I main-tain a part-time faculty appointment in the school ofnursing where I am lead faculty in the master’s andpost-master’s GNP program.

My involvement in NCGNP started while teachingat the nursing school when I saw a flyer about theNCGNP conference in Atlantic City. I had never heardof the organization before and attended my first con-ference at Mayo Clinic in Rochester, Minnesota, in1990. Phyllis Freeman, president-elect, encouragedme to get involved in the organization by attending acommittee meeting. I chose the newsletter committee

(Rose Schmidt was editor) and agreed to write the

Geriatric Nursing, Volu

“Spotlight on a GNP” column. Later I became editor,then treasurer, then president of NCGNP (1996–1997);currently I am co-chair of the Historical Committee.

Shortly after my term as president of NCGNP, theAmerican Nurses Association (ANA) formed a work-group to review and revise the Scope and Standardsof Gerontological Nursing Practice, first published in1976. I was appointed to be the representative fromNCGNP. It was a wonderful opportunity to work witha group of 5 other gerontological nursing leaders,including Dr. Barbara Resnick, to update the stan-dards. We made major revisions consistent with theemerging evidence behind clinical gerontologicalnursing practice. We expanded the content on ad-vanced practice gerontological nursing considerably,reflecting more appropriately the APN role.

The needs of the hospitalized elderly are tremendous,and although we have made significant progress, a greatdeal more remains to be done. My colleagues andfriends in NCGNP are always supportive and providean incredible network of resources. Obtaining thenecessary resources to do so in an era of cost con-tainment and competing interests and needs has beenchallenging. Medicare reimbursement for NPs made ahuge difference, and it has enabled us to expandGNPs in long-term care. Broadening prescriptive au-thority in Virginia has enabled NPs to manage com-plex pain management and provide better end of lifecare. I would like to see the scope of practice expandedeven further, such as permitting GNPs to function asmedical directors in long-term care facilities.

I am thrilled to see the growth and maturity ofNCGNP over the nearly 20 years that I have been amember, and I am very proud to have been andcontinue to be a part of it. I have three pieces ofadvice. One, I would suggest that GNPs not be timid.If you have an idea for improvement, propose it. Lookeverywhere for resources. If one door closes, lookaround for another one to open. Second, I encourageall GNPs to become involved in professional organi-zations including ANA and NCGNP. It is criticallyimportant that the standards continue to be devel-oped and revised, reflecting the evidence supportingbest practices. Certain areas of volunteerism such asstandard development, test development, and ad-dressing legislative issues do not have the appeal tothose focused on direct patient care, but cliniciansneed to go beyond this if change in practice andimproved quality of care to older adults is to beaccomplished. Finally, I advise GNPs to make a com-mitment to lifelong learning. I completed my under-graduate degree 37 years ago, my graduate degree 26years ago, and am currently enrolled part time in theDNP program and expect to complete it in 2009. I liketo say that I am both a student of geriatrics and a

geriatric student. One of my favorite perks: on Tues-

me 29, Number 4 249

days at the Kroger’s, I get both my student and mysenior discount!

NCGNP PioneersThis completes our series on the pioneers of our

organization. All contributed in some unique andvaluable ways to ensure the success of the organiza-tion and advanced practice care for the older adult.We appreciate their service as we continue to reapthe benefits of having an organization to meet ourspecial needs. The persons profiled include all ofthose who were available for interview by the Histor-ical Committee in preparation for the 25th anniver-sary. We apologize for any persons we missed.

0197-4572/08/$ - see front matter

© 2008 Mosby, Inc. All rights reserved.

doi:10.1016/j.gerinurse.2008.06.012

WELCOMING ETHNIC ELDERS TO HEALTH

CAREKathleen Jett, PhD, GNP-BC

In 1970, those persons from ethnic groups that arestatistically underrepresented in the United Statesmake up approximately 16% of the population; by1998, that number had grown to 27%.

By 2050, this percentage is expected to increase toapproximately 50%, with the largest growth comingfrom those persons who identify themselves as His-panic.1 Although the precise number of ethnic eldersis unknown, it is reasonable to assume that the num-bers within the general population of both personsborn in the United States and elsewhere are growing.The states with the largest number of ethnically di-verse elders are California, Illinois, Florida, Nevada,New Jersey, Massachusetts, Arizona, Virginia, andMichigan.2

Gerontological nursing in these states in particularis likely to be or become a cross-cultural experience.As nurses, we are increasingly likely to provide careto older adults with differing life experiences, values,and interests from our own. As a consequence, it isbecoming increasingly important for gerontologicalnurses to develop skills and techniques that welcomeelders of all kinds into our care and our practices.Welcoming care is that which is available, affordable,accessible, and acceptable.

Gerontological nurses are often in a position to beavailable to make care accessible for older persons.We provide primary care in nursing homes, assistedliving facilities, and person’s homes. We can alsooffer flexible hours and appointments when appropri-

ate and possible. We often accept assignment, and

Geriatric Nursing, Volu250

some of us work in free or sliding-scale clinics con-tributing to affordable health care. Yet what can wedo to make sure that our care is acceptable to allelders, including those from backgrounds dissimilarto our own?

You might try the following to help make yourpractice more welcoming.1. Make your care environment culture-friendly:

use artwork and colors that reflect the culturallydiversity of your patients. Hire diverse staff thatmirrors your consumers.

2. Be open to the type of services that best meetthe needs of the patient. Develop relationshipswith indigenous healers.

3. Know the taboos and myths of the community andact accordingly. Do you ask before touching?

4. Pay attention to the nonverbal messages—yourpatients and your own. It may be the loudestmessage given.

5. Be aware of the communication styles that areacceptable and unacceptable to your patients.Do you know the preferred mode of greeting orname use?

6. Always be aware of your own values and thenatural inclination to stereotype.

7. Always clarify your role and the purpose of anyclinical encounter.

8. If working with persons with limited Englishproficiency, have an interpreter available andavoid dependence on patients’ family or friendsunless there is no other choice. Remember thatthe more complex the decision, the greater theskill of interpretation that is necessary.

9. If working with an interpreter, know how to doit (see resources that follow).

10. Provide teaching materials that not only are eth-nically appropriate but that also reflect an ap-propriate reading level.

References

1. Administration on Aging. (2002). A profile of olderAmericans: 2002. Available at http://www.aoa.gov/prof/

Statistics/profile/1.asp. Cited June 12, 2008.2.2. Gelfand, D. (2003). Aging and ethnicity: knowledge and

service. 2nd edition. New York: Springer PublishingCompany.

KATHLEEN JETT, PhD, GNP-BC. This issue is the final

work of Dr. Jett as NCGNP section editor. She has been a

long-time member of NCGNP and a practicing and teach-

ing GNP. Dr. Jett has recently assumed the position of

heath scientist administrator at the National Institute of

Nursing Research.

0197-4572/08/$ - see front matter

© 2008 Mosby, Inc. All rights reserved.

doi:10.1016/j.gerinurse.2008.06.020

me 29, Number 4