Nursing has established itself as the profession that cares for the elderly. In the future, the scope of the professional role of gerontologicai nurses (GNs) will be further expanded to address some of the emerging needs of a growing and demographically changing older population. As a response to these changes, health care will become more community-based, competitive, demanding, health -oriented, and diverse.
The future direction of health care is uncertain, but some major influences will include the development of group or community housing arrangements with a sharing of tasks and assets as the primary goal; the national distribution of portable emergency and communication devices; the development of a planned, orderly, and appropriate transfer of patients to and from hospitals and nursing homes; the introduction of nonphysician medication clinicians as primary prescribers; theevolvement of health-based educational and experiential requirements as a preliminary basis for nursing home administration; and the development of a well-delineated plan for direct governmental and private insurance payment to nurses for services rendered.
As the older population grows and becomes more divergent, the demand for nursing service will mandate an adjustment and expansion of the GN role. GNs and the profession must consider the impact of the changing demographic characteristics of the older population. Because individuals become more diverse as they age, it must be recognized that the increasing longevity of minority group members and men will present major challenges to al I health-care workers. To meet these challenges, nursing must develop an aggressive recruitment plan to attract men, mature adults, and minority group members into all levels of the profession's hierarchy. These individuals would provide masculine, mature, and cultural insights that will form the pragmatic perspective for assessing, planning, and implementing appropriate health-care regimens.
In addition, nursing must explore the further development, integration, and refinement of its health screening, promotion, and maintenance orientations. These activities should become a function of community-based service organizations frequented by the elderly. Nursemanaged, specifically designed programs that include recreation, financial counsel ing, and educational programs that specifically focus on the holistic health problems of aging women need to be planned.
The GN role must be broadened to include limited, although direct, prescriptive responsibilities. This expanded, optional specialty subrole will mandate specific, regulated preparation. The complexity of the aging process will ultimately result in the introduction of drug investigation programs that focus on the relationships between medications and the aging physiological and psychological systems. The need for this prescriptive subrole is especially relevant as a vital component in drug administration within the nursing home.
Qualifications for assuming administrative, financial, and leadership roles in nursing homes should be based on registered nurse licensure with additional specific taskoriented preparation. It is inconceivable that non-nurse administrators with little, if any, specific educational health-care preparation or experiential background have the administrative responsibility for making nonclinical decisions that directly affect the clinical care provided.
Expanding responsibilities mandate the development of a hierarchy of expertise within the field of gerontological nursing, with the major foci being clinical, administrative, and educational divisions. The educational division must focus on gerontological nursing research. The complex health-care problems of the older adult, especially elderly women, should become the initial research area.
Another need, seldom addressed but evident, is the recognition of the personal and professional needs of GNs as the primary providers of care. Nurses, as part of society, are also growing older and living longer. Older nurses will have the same holistic and financial needs as any other member of the population. The long-term financial, health-care, and social needs of older nurses, who are predominantly women, need to be addressed. Professional nursing must develop a data-based benefits agenda that seeks to document the need for transferable retirement plans, assistance with financial management, and a nationwide vehicle to formalize professional courtesies as a legitimate recognition of the profession.
Nurses, as a political force, can do a great deal for the profession, the elderly, and themselves by using their social, organizational, and leadership skills to develop an agenda of goals. The potential political power of GNs to educate legislators about the needs of the elderly and those who care for them needs to become publicly recognized. GNs will need to become more assertive through their involvement in local, state, and national nursing and political organizations.
The future of gerontological nursing practice will be determined by a plan that is acceptable, reasonable, and beneficial to all nurses. Establishing a structure to formulate this plan will require the establishment of a multi-focused "think tank" group of GNs. This group should be comprised of GNs who have demonstrated expertise in the clinical, administrative, and educational arenas. The major purpose of this group would be to develop social, professional, and legislative goals and strategies that will most benefit the elderly and the GNs who care for them.
Influencing legislative decisions is a legitimate responsibility of a profession. The traditional approach of letter writing, contributing, and seeking election to political office must become more directed. A national, personalized, political strategy has to be developed. As one part of that strategy, legislators will be most influenced by individuals who share an interest and have recognized expertise in health-care areas and specialties that have most affected the lawmakers' personal lives. Allying ourselves with legislators who share common interests, regardless of political affiliation, is politically astute, professionally rewarding, and personally satisfying.
Nursing, as a profession, must assume its responsibility in the political arena by advocating an agenda that will improve the lives of all older adults. The increasing elderly population represents both a challenge and an opportunity for nursing. GNs can and should assume the leadership role as outspoken advocates for the elderly and for nursing so that the lives of the recipients and providers of care are simultaneously improved.
Henry M. Plawecki, RN, PhD