Have you applied for certification as a gerontological nurse? Have you ever wondered who has become certified, what positions they hold, what kind of people they are, how they got into gerontological nursing? We did.
As educators in a program designed to prepare nurses to assume leadership positions in gerontological nursing at the graduate level, and as nurses vitally interested in the quality of nursing and health care provided the elderly, we were interested in these questions from both curricular and professional perspectives. Of particular interest to us was whether the students who were coming to our graduate program had characteristics similar to the certified nurses identified as experts and leaders by their peers. As we examined the data collected to compare our students with the certified nurse groups, we became impressed with the numerous and varied positions and activities of the certified nurses and of their dedication to and enjoyment of gerontological nursing. We also found that many nurses were interested in the data we had generated. This paper, then, presents descriptive data about nurses who are certified in gerontological nursing. How these nurses compare to other gerontological nurses who have not sought certification is not known.
Certification is a peer review system that recognizes and rewards the nurse who demonstrates superior clinical performance and who provides leadership in promoting high quality care for the elderly. The certified nurse serves as a role model for the provision of nursing, care, and serves as a leader in the field.1
Certification, a concept introduced by the American Nurses' Association in 1974, recognizes the specialized clinical practice expertise of nurses; advanced educational preparation is not a criterion for certification. In 1974, the first gioup of nurses - 25 pediatric nurse practitioners and 74 geriatric nurses - were awarded certification.2 By 1979, 249 nurses were listed as certified in gerontological nursing.3
Data upon which this report is based were collected from 115 nurses, certified in gerontological nursing, by means of a mail survey conducted during the summer of 1979. This sample represented about one-half of the nurses listed as certified in gerontological nursing in the 1979 edition of the Directory of Certified Nurses.* Letters inviting participation in the study were sent initially to all 249 nurses certified in gerontological nursing; 1 15 of these nurses agreed to participate and completed the California Psychological Inventory (CPI), the Adjective Check List (ACL), and a demographic questionnaire. To supplement these data, a random sample of 15% of the participants were interviewed by telephone to gain additional data on the professional and personal experiences that led them into gerontological nursing. Respondents came from 29 states and one territory of the United States, the largest numbers from Wisconsin (ten), Florida (nine), and California and Pennsylvania (eight each).
The composite certified gerontological nurse was married with at least two children, was 48 years of age, had worked in nursing 20.9 years, and claimed a great deal of experience with chronically ill or older clients. She was a graduate of a diploma school, probably in the Northeast, had attended continuing education classes within the past three years, but was not working toward a formal degree. She held membership in two professional organizations, was employed full time as a director of nursing service, a position she had held for less than five years. Her annual salary was between $15,000 and $19,000.
AGE, MARITAL STATUS, ETHNICITY
The mean age for the certified nurses was 48. 1 years, although ages ranged from 30-69 years.
Seventy- two percent* of the nurses were married, 15% single, 7% divorced, 2% separated, and 4% widowed; 85% had children (range of one to eight children). All respondents were female. Ninetyseven percent of the nurses were white, 2% Black, and 1% had a Spanish surname.
Seventy-four percent of the certified nurses obtained their basic nursing education in diploma schools, 9% in associate degree schools, 17% in baccalaureate schools, and 1% in a generic masters program. The most common location of this basic program was in the northeastern United States (30%). The second most common area was the Midwest (26%), followed by the South (13%). Twenty-seven percent of the nurses had baccalaureate degrees, 25% had masters degrees, and 2% had doctoral degrees.
Sixty-one percent of the nurses had completed their basic nursing preparation over 20 years ago, 23% between 1 1 and 20 years ago. Of the 66 nurses who had completed a degree, 71% had completed it within the past 10 years.
Forty-one percent of the respondents were working actively toward degrees or advanced certificates. Thirty-eight percent of that group were seeking baccalaureate degrees, 30% masters degrees, 6% doctoral degrees, and 26% were pursuing organized programs toward advanced certification, for example, counseling, nurse practitioner. The majority of these nurses (86%) were enrolled on a part-time basis. All but one respondent had attended continuing education courses within the past three years.
There were no statistically significant relationships between age and pursuit of a degree (see Table 1) or between age and type of degree among those respondents pursuing degrees (see Table 2).
The certified nurse was active in professional organizations. She held, on the average, 2.1 professional memberships, the most common ones being memberships in the American Nurses' Association (85%) and the Gerontological Society of America (29%). Sixteen percent were members of Sigma Theta Tau, the national honor society for nurses. Sixty- six percent of the respondents had held offices in professional organizations; 67% also were active in community organizations.
AGE AND DEGREE PURSUIT
Thirty-five of the respondents had published.
The certified nurse had worked for an average of 20.5 years, although a wide range - five to 44 years - was reported. The certified nurses were employed in a variety of positions and employment settings; the most commonly cited position was director of nursing (34%). Ten respondents indicated holding combined positions such as hospital administrator, consultant, and inservice director; faculty member and nurse clinician; program planner and consultant; or head nurse/supervisor and inservice coordinator.
The range of positions held by this group of nurses was extensive. In addition to the more traditional nursing roles of head nurse, supervisor, staff nurse, and faculty member, certified gerontological nurses reported employment as nursing home administrators (six), rehabilitation clinical coordinator/specialists (three), consultants for state health department (two), assistant directors of health services (three), directors of research/demonstration project (two), program planner, director of quality assurance, and pastoral care associate, to name just a few.
Age and employment position were related only in that the mean age of nurses employed as inservice directors or coordinators was greater than that of the respondents employed as staff nurses (using Duncan's multiple-range test, p<1.05).
The greatest number of the nurses were employed in skilled nursing facilities or nursing homes (52%). Nine percent reported employment in an acute care facility and 28% indicated a range of nontraditional employment settings such as mental health clinics and private practice settings.
The modal annual salary for fulltime employment ranged from $15,000 to $19,000 (36%). Thirty percent of the nurses indicated a salary between $20,000 and $24,999, 17% reported between $10,000 and $14,999, 7% indicated under $10,000, and 10% indicated over $25,000. When one considers the positions many of these nurses held - director of nursing, inservice educator, nursing home administrator, mental health clinician - it is evident that these nurses were not highly paid.
AGE AND TYPE OF DEGREE SOUGHT
Most of the respondents (92%) were employed full time. Almost half of the respondents (47%) had been in their current positions five or fewer years. Twenty-six percent of the respondents had held their current positions for between six and ten years, 21% between 1 1 and 20 years, and 8% over 21 years - again, a broad range. A few respondents indicated they were no longer in gerontological nursing, although reasons for leaving were not cited.
There was a statistically significant correlation between degree and salary (R=0.2314, p>.01). While the distribution of salaries was very similar for nurses with and without baccalaureate degrees, more of the nurses with advanced degrees received higher salaries. The modal salary range for non-degreed or baccalaureate respondents was $15,000 to $19,999; the modal range for respondents with advanced degrees was $20,000 to $24,999. Of the 11 respondents who earned over $25,000, four had no degree, three had baccalaureate degrees, and four had masters degrees.
The tools utilized to develop personality profiles were the California Psychological Inventory (CPI) and the Adjective Check List (ACL). These tests are designed to assess personality traits (lasting, permanent, or long-term factors), rather than states (short-term, changeable factors). These tests have been used in numerous studies with a variety of professional groups.4'5 Group profiles were developed for each test.
The personality characteristics found associated with the certified gerontological nurses were those that one would expect (or hope) to find associated with nurses who are leaders in the field.
Adjective Check List. Adjectives associated with the profile of the certified nurses developed using this measure were: self-controlled, hard-working, strong-willed, dependable, concerned, intelligent, idealistic, confident, and conscientious.
California Psychological Inventory. Properties associated with the CPI profile developed were: possession of leadership potential and preference for achieving in unstructured settings or those that require independence of goal-setting and action. Adjectives associated with this profile were: expressive, enthusiastic, independent, insightful and confident, intelligent, resourceful, self-assured, verbally fluent, and rebellious toward rules.
The personality profile suggests that certified gerontological nurses possess a combination of the attributes Miller6 found associated with medical-surgical majors (dependable, sincere, and conscientious) and community health majors (independent, resourceful) in her study of graduate nursing students at the University of California, San Francisco. The profile also contains some of the attributes that Dyer, Cope, Monson, and Van Drimmelan found associated with head nurses and supervisors who scored high on measures of nursing performance (social presence tolerance, achievement through independence, intellectual efficiency, psychological mindedness, and flexibility).7 It appears that certified gerontological nurses embody the positive attributes associated with nurses from several subspeciality areas. White,8 in her study on pediatric and maternity nurse practitioners, concluded that it is the balance of superior traits, rather than outstanding single trait scores, that is associated with successful practitioners. This also may be true for the gerontological nurse.
Telephone interviews were conducted with 19 of the 115 respondents (approximately 15%). These persons were selected at random from the total sample of certified nurses who agreed to participate in the study. The age range of this group was 31 to 66. Years in nursing ranged from eight to 44 years. The group represented all levels of nursing education (diploma to doctoral candidate) and 17 states.
Of particular interest were the factors the respondents identified as leading them to specialization in gerontological nursing. Seven of the 19 respondents indicated that working with the elderly had been a life-long interest and they selected their employment positions, and even some of their learning experiences in their basic nursing education, to further that interest. Generally, these respondents had positive experiences with the elderly prior to entering nursing, although one person credited her interest in the elderly to the lack of such contact. Ten respondents reported that entry into the speciality was quite happenstance - one through the availability of a job close to home, three as initial re-entry into active nursing, and three as a result of developing interest in the elderly through on-the-job exposure to this population. Two respondents credited experiences in their basic nursing programs with stimulating interest in the field.
Of the 19 respondents, five were currently, or had been at one time, members of a Catholic religious community.
All of the respondents spoke of the challenge of gerontological nursing. One respondent stated:
"I had been an operating room supervisor. . .1 had done emergency room, operating room. I had varied experience, but when I got into geriatric nursing I found that I was using all my knowledge. . .1 felt I was playinga much more important role. I was the only contact between the doctor and the patient, and I felt that I needed all the skills that I had ever learned to do a good evaluation on my patients. . .and it was a rewarding challenge."
Another, a VNA nurse, stated:
". . .and I had done the bit with intensive care in the hospitals and all die real technical types of nursing and I enjoyed the observation, assessment, the teaching that needed to be done with this type of clientele."
A nursing home administrator responded:
"I really like it, and I think one of the reasons I like it is I have a free hand to be as progressive as I want to be, to learn as much as I want. . .to change a few negative attitudes about people. . ."
They also spoke of the joys of working with older people:
"Elderly people are just priceless pearls as far as I am concerned. They tell it like it is. They don't waste time with games."
"They (younger people) don't have the maturity and depth of personality that I find in the majority of older people."
"...maybe because it's diversified; you get a little family counseling, a little working out problems with patients, and you cultivate your skills in handling problems."
". . .they (the elderly) show much appreciation for little things that are done for them.
"There's all kinds of undiscovered worlds that keep you in. .."
"People are more real, maybe that's the best way to put it."
IMPLICATIONS FOR EDUCATION AND SERVICE
These nurses showed a great deal of educational mobility - although over four-fifths of them obtained their basic education in non-degree programs, over one-half had obtained at least a baccalaureate degree, and almost half were currently enrolled in an educational program on a part-time basis. Educational programs, then, must be sensitive to the needs of these nurses for programs fostering part-time attendance. While this usually is not problematic at the graduate level, baccalaureate programs in nursing frequently require fulltime attendance. It is evident, also, that there continues to be a need for organized programs that are not oriented to completing a degree.
The mean age of these nurses, their rich experiential background, and the comparative recency of their degrees, suggests nursing programs are attracting older, experienced students and thus need to design curricula appropriate for these learners, for example, developing assignments and learning experiences that build upon prior knowledge and experience, offering contractual learning with mutually set goals, and developing preceptorships in the student's locality to facilitate meshing the time demands of employment and education.
The personality profiles also offer some data about the types of students these nurses might be, providing guidance for the structuring of learning experiences and perhaps helping faculty to anticipate and alleviate frustrations that seem inherent in returning to the educational setting. The message for service settings is similar to that for the educational settings - many nurses are highly qualified, committed, and interested in increasing their knowledge and skill base while maintaining employment.
It is evident that service and educational settings need to be flexible, to cooperate, and to recognize the needs and interests of their constituents. The salary levels of these nurses are very low. If service settings are to attract and retain high-caliber nurses, salaries must be commensurate with preparation and practice. Advances must be made on this front also! Service settings could assist nurses in furthering their educations through scholarships and fellowships. Educational institutions are developing on-going affiliations with longterm care settings, as is now being promoted through a program by the Robert Wood Johnson Foundation. Perhaps this cooperation between education and research and service settings will increase nurses' interest in gerontology, increase interest in nursing research in the long-term care setting, and increase appreciation of the members of the academic community for the needs and problems in the long-term care setting.
Data generated by this study revealed that a group of nurses certified in gerontological nursing were dynamic and active, both personally and professionally. Many of the nurses were working, attending formal educational programs, participating in professional organizations, and upholding family responsibilities. That 41% of the nurses were working toward formal degrees or certificates belies the stereotype that nurses in this field are "too old" to learn new skills and gain new knowledge, or are there because they can not "make it" elsewhere.
Although less than half of the interviewed group had consciously selected gerontological nursing as their career foci, once in the field, these nurses obviously became committed to this area, and enjoyed the challenges and the joys of working with older people. Life experiences, more than educational and professional experiences, seemed to influence their movement into gerontological nursing.
The personality measures indicate that these nurses possess the personality characteristics of leadership groups - energy, enthusiasm, persistence, resourcefulness, and drive. These people have the potential to, and actually are, effecting change in this area of nursing practice.
- 1. Weitzel E: In pursuit of ANA certification in gerontological nursing. Journal of Gerontological Nursing 1980, 6: 136139.
- 2. ANA, Statistics Department: Report on Certification Evaluation and Impact for the Initial Recipients of ANA Certification. Kansas City, MO, American Nurses' Association, 1975.
- 3. ANA: Directory of Certified Nurses. Kansas City, MO, American Nurses' Association, April 1979.
- 4. Gough H, Heilbrun A: The Adjective Check List Manual. Palo Alto, Consulting Psychologists Press, 1965.
- 5. Gough H: Manual for the California Psychological Inventory. Palo Alto, Consulting Psychologists Press, 1975.
- 6. Miller D: Characteristics of graduate students in four clinical nursing specialties. Nurs Res 1965, 14:106-113.
- 7. Dyer E, Cope M, Monson M, et al: Can job performance be predicted from biographical, personality and administrative climate inventories? Nurs Res 1972,21:294-304.
- 8. White M: Competence and commitment: The making of a nurse practitioner. University of California, School of Nursing. 1978.
- The assistance of Jessica Muller, MS, in the collection and analysis of the interview data is appreciated greatly.
AGE AND DEGREE PURSUIT
AGE AND TYPE OF DEGREE SOUGHT