039. Ensuring Geriatric Patient Success: A Conversation with GNCC President-Elect Christina Holub

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Hello, and welcome to GAPNA Chat, an official podcast of
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the Gerontological Advanced Practice Nurses Association Gapnachat provides interviews and
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discussions with GAPNA leaders and members of the gerontological healthcare community,
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and will focus on advocacy, policy, education, professional development, research,
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and clinical care for older adults. Before we get started,
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if you are an advanced practice nurse caring for older
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adults and want to further your career, GAPNA encourages you
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to sit for the Gerontological Specialist Certified Exam and earn
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your GSC credential. This expert certification distinguishes APRNs with the
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knowledge and experience to manage the complex health needs of
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older adults. Visit gerrosert dot org to learn more. In
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this episode, doctor Cassan Dravonestes, a gerontological nurse practitioner and
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member of the GAPNA Communication team, talks with Miss Christina Hollub,
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league nurse practitioner and Geriatric Surgery program coordinator at Lehigh
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Valley Health Network in Allentown, Pennsylvania, and President elect of
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the Gerontological Nursing Certification Commission Board. Miss Hollub discusses her
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interest in geriatrics and how this specialty has positively impacted
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her life, career and leadership positions. She provides a deeper
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dive into the Gerontological Surgical Verification GSV program at the
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Lehigh Valley Health Network, including its impact, importance, and focus.
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She goes on to highlight the importance of post screening,
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patient education, management plans, and interdisciplinary communication in ensuring the
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long term success of patients at home or in care facilities.
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We are pleased to present doctor Vonas's interview with Christina Hullub.
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Hello everyone, and welcome to Gapna Chat our series seven
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and our guest today is Christina hollob And. Christina is
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a Board certified family nurse practitioner and gerontological specialists with
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over thirteen years of nursing experience focused on perioperative care,
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complex geriatric medicine, and health care quality improvement. She currently
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serves as the lead nurse practitioner and Geriatric Surgery Program
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Coordinator at Lehigh Valley Health Network, where she helped implement
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one of only a few nationally recognized geriatric surgery programs
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verified by the American College of Surgeons. Her work specializes
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in perioperative geriatric assessment Gold concordant care, polypharmacy management, and
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reducing complications and hospitalizations among medically complex older adults. Christina
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also serves as an elected Board of Commissioners and President
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elects for the Gerontological Nursing Certification Commission and contributed as
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a GNCC expert in national credentialing standard setting for the
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Gerontological Specialist Certified Examination. Her professional passion centers on advancing
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excellence in gerontological nursing in her disciplinary collaboration, and improving
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outcomes for older adults through evidence based patient centered care
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for the aging population. Thank you for joining us today
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on gabne Chat. Christina. Congratulations on your election as President
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of the Gerontological Nursing Certification Commission Board. What is your
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origin story for nursing and primarily geriatric?
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Thank you so much for having me, Sandy, I'm really
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happy to be here. And that was a long winded
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I've been That's a lot of words. I'm sorry to
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read all that. Basically, you know, it's funny. I get
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this question a lot, especially when I talk to a
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lot of like nursing students and things like that. I
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used to teach nursing at the university of Massachusetts, Boston,
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and a lot of people would always say, like, what
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got you into nursing? And I think everybody has that
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point in their life where you know, you either knew
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somebody that was sick. Our lives have all been touched
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by healthcare and by a nurse or nurses that have
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helped a family member and a time of need. And
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it was always an interesting thing to me that didn't
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come to light until I was actually in college. I
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was a journalist major, which thank god I didn't go
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through with that when I had a family member come
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and live with my aunt came and lived with us
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on hospice and so needing to be home and giving
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her all those medications and treating the pain, and it
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was brain cancer at the age of fifty. So I
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think seeing that realm and being that those hands and
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being that heart and the science behind it and kind
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of that beautiful marriage between all of that and critical
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thinking and what next, And I think that is so
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intriguing for so many people, and in a way that
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only nursing can be. And then Geriatrix is just I
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get that question a lot, being my age, and they say, well,
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why don't you want to do children, Why don't you
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want to do this? And I think geriatrix is totally
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understated because when they lose that filter and they just
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want to say it as it is, there is just
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nothing funnier and nothing more uplifting. And they just constantly
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ground you in life and what's important and sharing their
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stories and what they've found to be true, and you
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know the importance of taking day by day and your
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family and spending the time. So I find that that
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honesty and that constant making me feel so appreciative for
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the life that I have and where I am in
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life right now is so important to geriatrics, and it's
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such a beautiful thing. But it's also the complexity of
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it too, and kind of this is the niche where
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you have to really think there's a fine line. If
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I push too much, then I kind of drop off
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another shoe. If I do too little, then I don't
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fix enough. And I think that that complexity also for
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a lot of us that are critical thinkers, that is
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really really intriguing.
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We're so fortunate to have you in our specialty and
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we're glad that you're here.
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I wouldn't be anywhere else.
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So you are the coordinator for the Gerontological Surgical Verification
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or the GSB at Lei Valley Health Network. Will you
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share a little bit with us about this program and
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along with some lessons that you may have learned on
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this journey.
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Absolutely, so I was actually hired. I was picked for
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this job a couple of years ago. So the GSB,
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the Geriatric Surgery Verification Program is an American College of
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Surgeons quality initiative. They have plenty and I'm sure a
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lot of hospitals and a lot of other nurse practitioners
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the part of it. They have ones in oncology, they
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have ones in trauma, they have ones in bariatric and
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so back in twenty nineteen, the originally, you know, seeing
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how the population is aging right now, and to see
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that they are the largest segment of the population that
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is growing, and to see kind of the cost of
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everything right and readmissions and polypharmacy. So there was really
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this deep dive into how do we kind of create
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these quality initiatives to kind of set standards to create
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pathways for these vulnerable patients. So this was set forth
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in twenty nineteen. They came out with thirty two standards
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and unfortunately in twenty nineteen, we all remember what else happened,
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So that kind of took a back burner during a pandemic,
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and then you know, it really kind of surged back
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into existence, especially after that. So a lot of that
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goal concord and care and kind of making sure we're
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focusing on advanced care planning and things like that. But
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the interesting part is when you look at the percentages,
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especially like more than forty percent of impatient surgeries are
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done now on patients that are older. We're doing a
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really great job keeping people alive for a really long time.
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But that doesn't mean that those complications and those needs
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for surgeries and polypharmacy doesn't kind of rear its head,
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and then we still need to do these emergent surgeries
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or even elective surgeries, right, because age is just a
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number for some patients. So I think one of the
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beautiful things about this program is that it focuses a
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lot on managing complex cormorbidities. Right. It focuses on risks
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associated with prognosis. Right, So it's not even just delirium
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and readmissions, but we're talking a lot about prognosis. We're
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talking about burden of care all of these huge things
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that we're seeing kind of move forward with these forums
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framework and this Age Friendly Leadership we're now embedding. And
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the GSP was actually created initially in conjunction with the
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John A. Hartford Foundation, and so the new CMS initiative,
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and I'm not sure how many people are in the
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acute care hospitals, but the GSV is actually the basis
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for the new CMS initiative, for that age friendly care
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that's being pushed out to all hospitals in twenty twenty
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five for us to meet certain standards. So there are
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kind of five domains that we are mandatory to meet,
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and that's eliciting patient healthcare goals, goals of care, making
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sure that we're doing the right thing for them, responsible
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medication management, frailty screening, and intervention, because we know that
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frailty is an umbrella, but it's a whole entire syndrome
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that kind of feeds off of each other, like malnutrition,
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you know, ambulatory dysfunction, cognition, all of those things things
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kind of work together or work against us. Social vulnerability.
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You know, we know they're not eating as much when
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they're home and they're alone. They're not going to cook
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a whole meal for just one person, and then having
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that aage friendly leadership is such a huge part of
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it as well. So I think that with the John A.
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Hartford Foundation and then the American College of Surgeons and
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now CMS, it's kind of this huge melting pot that
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we're all trying to come up and set forth a
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pathway and protocols to really help this population.
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I'm just curious, what in your health system have you
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used for your frailty screening. What kind of geriatric screening
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did you incorporate into that, you know, pre opt, visit
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and then follow the patient during their hospitalization.
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So ironically, so I am the only nurse practitioner currently
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running this program. So I do the emergent and I
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do the electives. So not only do I see the
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patients that are coming in electively that they know they're
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going to have some sort of admission, but I follow
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the emergent ones that are coming in through the ed
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as well. And so when we screen them, we're actually
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using the Edmonton and we're using the clinical Frailty Score,
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So we have to kind of meet all of these
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frailties cognition, delirium, nutrition, mobility, function, palliative screening is a
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new one that's mandatory. So we use the surprise question
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of whether or not we think this person will pass
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within the next twelve months with or without surgery, and
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so kind of each of those vulnerabilities, even age, if
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they're over the age of eighty five, they're automatically high risk.
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And then we kind of associate and we make sure
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that we kind of match up those interventions dysphasia. You know,
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who are we consulting it. It's a huge push for
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interdisciplinary team and then kind of goal concord and care,
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which is a huge part as well.
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And I know that swallowing has become a huge interest
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in the inpatient older adult population. How many times we're
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missing silent aspiration? Oh my god, that's.
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Where I consult them on everybody because the amount of
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vietal hernias and presby esophagus that I come across that's incidental,
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it's huge.
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And are then you doing a comparable screening prior to discharge?
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So you is one hour standards to see where they're
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where they're standing.
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Absolutely they're screening, So great question. So yeah, I usually
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screen them when they come in and then I screen
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them before discharge and so basically a lot of the
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times whatever was positive beforehand, obviously surgery did not make
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a whole lot better. If anything, we might have more
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vulnerabilities as a result, like mobility or function. We actually
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do monitor post up. Deconditioning is a whole term that
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we monitor as well. And then you have to screen
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at discharge as well and create a vulnerability plan. So
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it's one thing to screen and say, yeah, they're high risk,
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but what are we going to do about that? What
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is the management plan? What's the intervention because that's where
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these patients kind of fall through these cracks because we
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can say, yeah, their nutrition wasn't great, and then we
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send them home and then they continue to not eat.
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It's like, what is the plan once they go to rehab,
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once they go home, and it's all of that education
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and all of those plans kind of communicated with the
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primary care or with the acute care facilities at discharge,
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so that we kind of cushion that in that time
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span to kind of help with those readmissions as well.
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But I will say, is your facility a niche hospital?
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We are, So that's one of the things.
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That I had leveraged is using our geriatric resource nurses
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to do some of the screening and then automatically proposed
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consultation based on the positive screens.
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Because you can't do this alone, Christina, I know I
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don't take a lot of vacations, but our nurses, I
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will say, I don't know about anybody else's ratios.
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I know our ratios here are a little wild. So
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there was no way to kind of tack this on
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to additional screens and things, especially with the forums that
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we're implement that they're already documenting as well. So it
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is kind of one of those things that we're trying
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to push even just on providers, including the surgeons since
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I work in the surgical department, the residents, and kind
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of just really honing in on a lot of education.
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So I did get them to include it in all
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of their trauma h and ps because they were finding
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that once we kind of included that frailty score that
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really decided whether or not their palliative screening should be
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involved and doing the best case, worst case scenario since
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we were also a pilot site for that as well.
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So it was a really interesting thing that just including
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it and making them have that dot phrase were on
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EPIC for our EMR was a huge gateway for them
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to kind of really start thinking about this as an
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umbrella term rather than just kind of looking at an age.
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Any way, you can automate the screening, it's going to
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make it the provider us.
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We did create a whole navigator yeah too, which was great.
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We found that our case managers who spent time with
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the patient in making those decisions became valuable in that
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vulnerability screening because they were the ones that you know,
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helped initiate a lot of the DMV and yeah, the
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d m.
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Urbal medical guy, I got job, We're on the same way.
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So they were.
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They were the ones you know, helping with you know,
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knowing whether they were to be placed, whether they needed
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home help. So they were very attuned to where the
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patient was progressing at discharge. So we looped them in
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to some of that vulnerable.
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They are necessary, so there are necessary IDT members that
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have to be part of it. So I do run
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all of the Quality Committee meetings so quarterly, and we
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go over all of the data and I represent like
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and I present all of the remissions and tracking of
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the orders and tracking of IDT and then I do
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do like an eminem as well, kind of like this
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is what we missed, this is what should not happen
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if we follow these protocols, and so case management and
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has been such a huge integral part of that and
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I'm so glad to see that they're being recognized. But
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we also include pharmacy. So pharmacy has been a huge
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role that we have included in all of our meetings,
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and we have to do an IDT conference, so when
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we have these patients come inelectively, it's such an interesting part.
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In the way I describe it, it's kind of like
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a tumor board that you would think for oncology, but
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we do it for geriatrics, so they score high risk.
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Now I have geriatrics on board, like we have our
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chief of Geriatrics that actually sits on the board with me.
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We have pat r anesthesiologists sits on there, we have
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like medical directors from all over. So really that leadership
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part of it has been so huge. But then we
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also have palliative involved so that I can get them included,
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nutritionists involved, so really we can kind of brainstorm the
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best plan forward for these patients, which has been so huge,
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And I've even had patients admitted free operatively for like
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TPN for nutritional status optimization. So I will I will
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say as much as we talk about this pro and
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how great it is, I will say too that the GSC,
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so the Geriatric Specialist Certification as well that I sit
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on as the president elect. I cannot speak enough about
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how great that that certification has been and how much
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that involvement and that constant need for kind of pushing
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you to learn more and to read more and to
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be certified more and to be an expert in your
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care because when you look at these patients and you
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see how frail they are, and you see all these
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complex comorbidities, and they're on so many different medications, and
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knowing the difference between Beer's criteria and which medications we
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can prescribe and which ones we shouldn't and which ones
301
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are interacting. I think knowing and having that knowledge and
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having that expert level competency has made such a huge role,
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and not only my practice, but for these patients alone.
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And then the education that I can then provide for
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the residents, because they don't get a whole lot of
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education in geriatrics during their rotations, and so kind of
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pushing all of that information and the nursing I created
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a whole entire TLC which is like our learning bundle
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for nurses how to differentiate delirium and like, you know,
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just kind of making sure that we're all identifying the
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correct things and that we're treating them when we can
312
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and preventing the things that we can has been a huge,
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huge part of this whole program and kind of my
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drive for this aging model.
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So so, how did your leadership, you know, being hired
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for this position as the GSP coordinator and then seeing
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that your your leadership skills grow in that setting, how
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did that help inform your current role as the incoming
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president because you had served on the board the corrects prior, right,
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and so so tell us a little bit about about that,
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and you know some of your personal experiences.
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I laugh a little bit when I think about the
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young nurses because I started off as a nurse's aid
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and kind of while I was in nursing school, and
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then went to nursing school and then became a nurse.
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And I was nurse for eight years before I went
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back and became an MP. And so you know, I
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worked full I worked two jobs while I was an
329
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MP school because I did part time, and and so
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I think back to like being a nurse's aida and
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now I'm like, I'm sitting on a national board now,
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and I'm a leader in this age friendly hospital leadership,
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and I'm talking on calls with you know, people that
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are so much brighter than I am that I have
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that are executives of like these huge organizations, and it's
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kind of amazing to think how each individual thing kind
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of ticks off and leads you to where you are.
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And I always joke with Sumlin, who is the president
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right now currently for the GNCC, and I always laugh.
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I said, somehow I wanted to go because the gap.
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Now when they had their pharmacology conference, they had it
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in Hawaii, and I was like all I wanted to
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do was go to Hawaii. And I signed up for
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this conference, and now all of a sudden, I'm the
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president elect.
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They they reeled you.
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They really didn't end with the wakiki beats, you bet
348
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they did. And so when we had gone and then
349
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I had signed up, and then I heard about this
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geriatric Specialist certification, gerontologic Specialist certification, and as somebody who
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is like a life. I think any every nurse is
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kind of a lifelong learner, whether or not we decide
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to keep going for certifications or whether we kind of
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do it for our own you know, knowledge. It's been
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such an interesting thing when you think back to the
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consensus model and all the changes that happened in two
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thousand and eight, you know, with kind of taking away
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some of that certification. So there is a huge gap
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in like, you can be certified, right, and you have
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that based certification, but that doesn't mean we have to
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think more about what's at the top of that pyramid, right,
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that certification and the specialty, and so we're losing a
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lot of that specialty by not having those GNPs and
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things like that. I mean, we have our AGNPs, which
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are wonderful, but you know, they cover a all gero,
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not just specifically gero. So when you know, when we
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look at trying to advance that knowledge specifically for geriatrics,
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sitting for that Gerontologic Specialist certification was kind of a
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no brainer. And seeing the questions and going through the
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study guides, it really did highlight just how much like
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I thought I knew, which I did, but I wasn't
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totally confident in my skills. And so when you think,
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I think the number now is I think about forty
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two percent of Medicare beneficiaries are cared for by nurse practitioners.
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So when you think about in primary care and just everywhere,
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when you think about that massive percentage of patients that
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are older that are seeking care from FNPs or AGMP,
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I mean, the care is comparable, right, But why wouldn't
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we want to have more knowledge and more specialty and
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more expert knowledge and caring for these patients that we
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know are more complex. So that was kind of a
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really interesting thing, and I feel like that leadership that
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I had in my role has just grown, and then
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that passion for knowing that we can do better and
385
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we should do better. And this population is turning into
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00:22:13.839 --> 00:22:18.279
sixty million people and we only have I think, in total,
387
00:22:18.440 --> 00:22:22.880
like ten thousand geriatricians if you count actual board certified
388
00:22:22.920 --> 00:22:28.279
AGS geriatricians GNPs and GSCs caring for them ten thousand
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compared to the sixty million that need to be cared for.
390
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There's a huge gap that we need to kind of cross.
391
00:22:34.200 --> 00:22:38.319
Absolutely. So you know, I hear about you you sharing
392
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your your personal reasons now you were trained as an
393
00:22:41.039 --> 00:22:45.599
FNP correct, so you know that's just the geriatric piece
394
00:22:45.720 --> 00:22:48.799
is just a very small, you know, part of your curriculum.
395
00:22:49.240 --> 00:22:52.519
And you know, when I think about the adult Jarrow,
396
00:22:53.000 --> 00:22:56.519
so we have now a cute tair adult Jarrow. And
397
00:22:56.640 --> 00:23:01.680
does the GSC hit on any care issues? Are is
398
00:23:01.759 --> 00:23:08.119
it very focused on that primary care jero specialty?
399
00:23:09.119 --> 00:23:11.240
So the GC is kind of a broad one. It's
400
00:23:11.240 --> 00:23:15.000
not specifically primary though. You could gear a lot of
401
00:23:15.039 --> 00:23:18.400
that towards a lot of the questions could be towards that,
402
00:23:19.160 --> 00:23:23.880
but it's just complex care management with when you do
403
00:23:24.000 --> 00:23:28.000
take into account that most of these patients have multiple
404
00:23:28.119 --> 00:23:32.480
chronic conditions, when you take into account or on multiple
405
00:23:32.519 --> 00:23:36.599
medications for chronic conditions, so it's not geared towards one
406
00:23:36.640 --> 00:23:38.960
or the other. I have found it super helpful, especially
407
00:23:39.000 --> 00:23:42.680
being acute care. I laugh because I remember going into
408
00:23:42.799 --> 00:23:46.319
FNP because I wanted to do adult GERO and people said, no, no, no,
409
00:23:46.359 --> 00:23:48.759
you won't be able to market yourself with that. You
410
00:23:48.759 --> 00:23:51.240
want to make sure you go into Family Nurse practitioner
411
00:23:51.319 --> 00:23:55.200
because then you're covered in your more marketable Christina.
412
00:23:55.240 --> 00:23:57.839
They told me the exact same thing in nineteen ninety
413
00:23:57.839 --> 00:24:01.200
three when I went the gnp out, you know, don't
414
00:24:01.240 --> 00:24:02.119
do it, don't do.
415
00:24:02.279 --> 00:24:05.200
It, yes, even though you know what you and I remember,
416
00:24:05.240 --> 00:24:07.599
I actually got into a very big and I love
417
00:24:07.640 --> 00:24:09.680
my Alma mater, don't get me wrong. But when I
418
00:24:09.799 --> 00:24:13.079
went and wanted to do specifically geriatrics, I found a
419
00:24:13.119 --> 00:24:16.160
preceptor when I was in school at a nursing home,
420
00:24:16.240 --> 00:24:18.119
and I said, this is the preceptor that I want
421
00:24:18.119 --> 00:24:20.720
to follow. I want to do, you know, geriatrics, And
422
00:24:20.880 --> 00:24:23.240
they weren't going to take those hours. They wanted me
423
00:24:23.279 --> 00:24:25.920
to go to drive to go to a prison, to
424
00:24:26.000 --> 00:24:28.160
do primary care in a prison. And I said, no,
425
00:24:28.480 --> 00:24:30.559
this isn't what I want. This isn't what I want.
426
00:24:31.119 --> 00:24:34.720
And so it's just funny how those things transpire and
427
00:24:34.720 --> 00:24:37.000
then you realize, you know, I fought for the right thing,
428
00:24:37.039 --> 00:24:40.039
and I know what I wanted. So the GSC is
429
00:24:40.200 --> 00:24:42.839
interesting because the way it's kind of cut up is
430
00:24:42.880 --> 00:24:49.279
it really emphasizes that primary nurse practitioner certification does not
431
00:24:49.480 --> 00:24:54.559
equal geriatric specialty expertise. Right, So when we think about
432
00:24:54.599 --> 00:24:57.640
sitting for our certifications and we sit for our boards,
433
00:24:58.119 --> 00:25:02.240
that is kind of like that tree level competent care.
434
00:25:02.720 --> 00:25:06.000
It doesn't mean that safe practice, safe expert.
435
00:25:06.839 --> 00:25:08.920
But when you get into the real world and you
436
00:25:08.920 --> 00:25:11.920
see that your patients are not all, you know, forty
437
00:25:12.000 --> 00:25:14.839
years old coming in for you know, elbow pain and
438
00:25:14.880 --> 00:25:17.359
you can do a quick assessment, you're getting these twenty
439
00:25:17.400 --> 00:25:20.440
minute appointments with these eighty nine year olds that have
440
00:25:20.960 --> 00:25:25.680
more medications than on two pages. You know, you'd want
441
00:25:25.720 --> 00:25:28.839
to have that extra knowledge or even where to find
442
00:25:28.920 --> 00:25:31.519
that information to kind of help guide your practice. And
443
00:25:31.559 --> 00:25:33.039
I think that that's a huge part of it, and
444
00:25:33.039 --> 00:25:36.400
that's kind of what this certification is really hoping to
445
00:25:36.480 --> 00:25:39.839
hone in on of not only how to answer those questions,
446
00:25:39.839 --> 00:25:42.200
but where to find those answers. And then Kaban has
447
00:25:42.200 --> 00:25:47.079
been absolutely wonderful and the information that they the educational practices,
448
00:25:47.160 --> 00:25:51.200
the education that they offer has been hands down amazing.
449
00:25:51.279 --> 00:25:54.759
Their conferences are always fabulous and have great wealth of knowledge.
450
00:25:54.960 --> 00:25:56.480
So I think that that's a huge part of it
451
00:25:56.559 --> 00:25:56.960
as well.
452
00:25:57.480 --> 00:26:01.079
So can you provide some information to our listeners if
453
00:26:01.119 --> 00:26:06.000
you were interested in taking the examination? What are some
454
00:26:06.279 --> 00:26:10.519
of the requirements to sit for the exam, the content
455
00:26:11.119 --> 00:26:15.519
and how many gsc APRNs do we have? Now a
456
00:26:15.559 --> 00:26:19.440
little advertisement for for your specialty absolutely.
457
00:26:19.839 --> 00:26:22.000
And the funny part is when I sat for this,
458
00:26:22.200 --> 00:26:24.160
not only did I kind of get roped into it
459
00:26:24.200 --> 00:26:26.440
and then kind of went to the angolf meeting to
460
00:26:26.559 --> 00:26:29.319
kind of help with the setting the standards. You know,
461
00:26:29.319 --> 00:26:33.599
when I first went through the GSV, the Geriatric Surgery
462
00:26:33.680 --> 00:26:36.759
Verification Program, one of the standards was if they score
463
00:26:36.839 --> 00:26:39.200
high risk, that they need to be evaluated by a
464
00:26:39.319 --> 00:26:43.519
geriatric specialist. Right. And so my thought process being a
465
00:26:43.519 --> 00:26:47.000
Family Nurse practitioner, being an FMP, it doesn't matter how
466
00:26:47.960 --> 00:26:50.680
much history I have, or how much work experience I have,
467
00:26:50.880 --> 00:26:54.200
or how much experience I have taking care of complex geriatrics.
468
00:26:54.480 --> 00:26:57.799
I didn't have that certification. I didn't have that.
469
00:26:57.920 --> 00:27:00.960
And you don't want to be an imposter. You're the coordinator.
470
00:27:01.440 --> 00:27:04.920
Don't be an imposter. And so I remember thinking a
471
00:27:05.000 --> 00:27:07.400
lot of places like refer out to geriatrics to do
472
00:27:07.480 --> 00:27:11.079
like a full evaluation. And I remember thinking, these patients
473
00:27:11.079 --> 00:27:12.960
have a hard enough time coming for all of these
474
00:27:12.960 --> 00:27:16.680
appointments to begin with, transportation wise, finding rides, finding things.
475
00:27:16.720 --> 00:27:19.880
Everything's so overwhelming. They've got to see their cardiologist, they've
476
00:27:19.880 --> 00:27:22.799
got to see their PCP, labs everything. Why would I
477
00:27:22.839 --> 00:27:26.160
make another appointment? Why would I take more time to
478
00:27:26.200 --> 00:27:28.000
make it. And I don't know about you guys, but
479
00:27:28.839 --> 00:27:33.000
I just called our Geriatric Flumbing Memory Center here in Allentown.
480
00:27:33.400 --> 00:27:36.480
Their wait time is they're booking out until December now
481
00:27:36.799 --> 00:27:39.160
because of that specialty, there just isn't enough. There is
482
00:27:39.240 --> 00:27:43.640
just you can't get anybody in December. It is meg.
483
00:27:44.960 --> 00:27:48.359
So I remember thinking, well, why can't I be that specialist.
484
00:27:48.519 --> 00:27:51.279
Why can't I be that geriatric specialist that can kind
485
00:27:51.319 --> 00:27:53.960
of cut out the middleman, get to the bottom of this,
486
00:27:54.119 --> 00:27:55.960
and then if I need some assistance, or if I
487
00:27:56.000 --> 00:27:57.880
need to do more research, or if I need any help,
488
00:27:57.920 --> 00:28:00.799
I always have that ability to reach and kind of
489
00:28:01.039 --> 00:28:04.640
get some supervising, you know, insight or anything like that.
490
00:28:04.759 --> 00:28:08.200
So that alone in itself, but not only that, but
491
00:28:08.279 --> 00:28:11.440
marketing yourself showing that you are an expert in this care.
492
00:28:11.519 --> 00:28:13.920
And I think with the huge boom in this population,
493
00:28:14.079 --> 00:28:18.039
which you know we've seen and it's all over the
494
00:28:18.079 --> 00:28:21.079
news right and with CMS cuts and with funding that
495
00:28:21.720 --> 00:28:24.920
there is no greater time than right now to invest
496
00:28:25.000 --> 00:28:27.880
in yourself, invest in your knowledge for your patients. And
497
00:28:27.920 --> 00:28:30.039
we know that you're going to keep getting patients that
498
00:28:30.079 --> 00:28:34.079
are older in sixty five so in regards to the requirements,
499
00:28:34.279 --> 00:28:38.799
so basically licensure you have to have an unrestricted RND license, right,
500
00:28:38.839 --> 00:28:41.599
you have to meet your state board requirements. As an APRN.
501
00:28:41.720 --> 00:28:45.200
You have to have a natural National certification for your
502
00:28:45.240 --> 00:28:47.799
APRN role, which I would hope you'd have because you're
503
00:28:47.799 --> 00:28:51.519
practicing anyways. But then you have to have a minimum
504
00:28:51.559 --> 00:28:55.279
of twenty five hundred hours as an APRN working with
505
00:28:55.400 --> 00:28:58.640
older adults in the last five years. And so basically
506
00:28:58.720 --> 00:29:01.519
that's you know, if you're on primary care, you're meeting
507
00:29:01.559 --> 00:29:05.839
that most likely anyways. And so and then we kind
508
00:29:05.839 --> 00:29:08.000
of want to make sure that you're you're meeting a
509
00:29:08.000 --> 00:29:11.039
certain CME for continuing education where you have to have
510
00:29:11.119 --> 00:29:16.680
fifty gerontologic specific hours within the last three years prior
511
00:29:16.720 --> 00:29:19.880
to taking the exam. And this really hones in on
512
00:29:19.920 --> 00:29:22.759
that you're going to This is for expert level care
513
00:29:22.839 --> 00:29:26.480
competent care for these patients. And so if you meet
514
00:29:26.519 --> 00:29:29.079
those standards, and you can definitely find the link online,
515
00:29:29.079 --> 00:29:32.079
so it's on the gap NO website, it's under certification.
516
00:29:32.200 --> 00:29:34.559
You can see everything there. They've done a wonderful job
517
00:29:34.680 --> 00:29:39.200
kind of setting that all up. The requirements. The application
518
00:29:39.440 --> 00:29:42.319
to sit for it. I do sit on the board
519
00:29:42.400 --> 00:29:45.359
within the commission as well that does the audits on
520
00:29:45.400 --> 00:29:48.559
the applications that come through. And then it's one hundred
521
00:29:48.559 --> 00:29:52.079
and seventy five multiple choice questions. You take it at
522
00:29:52.160 --> 00:29:55.720
a testing center. You have about four hours a lotted
523
00:29:55.759 --> 00:29:57.440
to kind of finish it. But I know a lot
524
00:29:57.440 --> 00:30:00.279
of people, you know myself, that it did not take
525
00:30:00.359 --> 00:30:03.160
nearly that time. And based on the most recent a
526
00:30:03.279 --> 00:30:06.640
golf meeting that I set on, the current passing rate
527
00:30:06.720 --> 00:30:10.119
for the GSC is seventy three percent. So when we
528
00:30:10.160 --> 00:30:13.480
look at the test blueprint, we really want to make
529
00:30:13.519 --> 00:30:16.119
sure the biggest portions really are kind of can you
530
00:30:16.279 --> 00:30:21.559
perform a comprehensive assessment of a complex older adult? What's
531
00:30:21.599 --> 00:30:24.119
normal for older and what's not? You know what I mean,
532
00:30:24.160 --> 00:30:28.319
Like things change, your body changes, your organs change, like
533
00:30:28.359 --> 00:30:31.359
the way you process pharma, cokinetics, everything kind of is
534
00:30:31.400 --> 00:30:34.680
affected differently with the aging process. And then you know,
535
00:30:34.799 --> 00:30:39.720
performing appropriate screening and diagnostic testing, treatment and planning of care,
536
00:30:40.240 --> 00:30:43.160
taking into account social determinants and health costs of some
537
00:30:43.240 --> 00:30:47.519
of these really expensive drugs. What are alternatives prescribing medications
538
00:30:47.599 --> 00:30:51.319
including that risk of kind of risks and benefits of pharmacotherapy.
539
00:30:51.799 --> 00:30:54.680
Some of these you know Beer's criteria is this, you know,
540
00:30:54.759 --> 00:30:56.680
anti coolinergic. Is it going to lead to a lot
541
00:30:56.720 --> 00:31:00.319
more problems with urinary retention or dry mouth? And then
542
00:31:00.440 --> 00:31:04.119
kind of a part of some of the questions less so,
543
00:31:04.400 --> 00:31:07.119
but some of the questions are kind of system based approach,
544
00:31:07.240 --> 00:31:13.200
so educational strategies and optimizing health outcomes resources to kind
545
00:31:13.240 --> 00:31:16.839
of optimize outcomes for patients that you know, again taking
546
00:31:16.880 --> 00:31:21.799
into account maybe sensory deficits, you know, cognitive deficits, things
547
00:31:21.880 --> 00:31:24.640
like that. So that's kind of the print currently right
548
00:31:24.680 --> 00:31:26.839
now when I just looked it up, we have about
549
00:31:26.839 --> 00:31:31.440
two hundred and thirty three active GSCs within our database
550
00:31:31.599 --> 00:31:32.440
that are verified.
551
00:31:33.519 --> 00:31:37.119
How can we market this to the clinical nerve specialist
552
00:31:37.200 --> 00:31:41.000
role because I know in a lot of vettings the
553
00:31:41.079 --> 00:31:46.519
CNS could still be a valuable asset in managing the
554
00:31:46.559 --> 00:31:48.519
care of the older adult population.
555
00:31:49.559 --> 00:31:53.519
Absolutely so. On the board for the GNCC, we have
556
00:31:53.759 --> 00:31:58.119
really been brainstorming. We've had multiple calls, multiple meetings of
557
00:31:58.240 --> 00:32:01.640
kind of doing more outreach. I think previously, you know,
558
00:32:01.720 --> 00:32:05.680
we kind of just marketed towards our nurse practitioners, and
559
00:32:05.759 --> 00:32:08.440
I think moving forward, we are really kind of honing
560
00:32:08.480 --> 00:32:11.559
in on those cns's, We're really trying to get a
561
00:32:11.599 --> 00:32:14.759
lot more FNPs. We're even trying to tailor this a
562
00:32:14.799 --> 00:32:18.920
lot towards educators and kind of helping those students that
563
00:32:19.039 --> 00:32:21.079
know that they want to do geriatrics, how do we
564
00:32:21.079 --> 00:32:24.119
get those educators to become certified as well, and kind
565
00:32:24.160 --> 00:32:27.640
of realizing that this is a huge thing to help
566
00:32:27.839 --> 00:32:32.920
provide expert level knowledge, and so again the consensus model, like,
567
00:32:32.960 --> 00:32:36.039
if you want to go into geriatrics, here's this wonderful
568
00:32:36.319 --> 00:32:39.240
certification that can kind of make stand you out as
569
00:32:39.279 --> 00:32:43.279
an expert level regarding geriatric care. So I would say
570
00:32:44.079 --> 00:32:47.960
we're trying to make it to more conferences, not just GAPNA. Obviously,
571
00:32:48.000 --> 00:32:52.240
we're kind of aligning, We're doing more outreach to different networks.
572
00:32:52.319 --> 00:32:55.480
We're doing a lot of incentives for optim but we're
573
00:32:55.480 --> 00:32:59.720
also trying to reach out to hospital networks and so
574
00:33:00.160 --> 00:33:02.640
large networks that we know kind of house a lot
575
00:33:02.640 --> 00:33:05.680
of nurse specialists and a lot of nurse practitioners and
576
00:33:05.759 --> 00:33:10.279
kind of educating about that need for higher level certification
577
00:33:10.400 --> 00:33:13.599
for expert level care. So that is kind of where
578
00:33:13.599 --> 00:33:16.440
we're pivoting right now, and it's been a really great
579
00:33:16.480 --> 00:33:19.240
thing to see the growth of this to expand because
580
00:33:19.279 --> 00:33:23.799
there are so many higher master's degree nurses that have
581
00:33:23.920 --> 00:33:28.440
such a huge integral part in these older patients, whether
582
00:33:28.440 --> 00:33:31.319
they're in primary care, whether they're in the hospital, that
583
00:33:31.400 --> 00:33:33.480
touch upon these patients that can kind of really move
584
00:33:33.519 --> 00:33:34.400
this ball forward.
585
00:33:35.279 --> 00:33:38.279
So is there a plan for the GSC to be
586
00:33:38.400 --> 00:33:42.839
recognized by the ANCC and how is that unfolding?
587
00:33:43.640 --> 00:33:47.319
So we had submitted an application, so it's not to
588
00:33:47.359 --> 00:33:50.759
the a n CC so as a specialty certification, right,
589
00:33:50.799 --> 00:33:54.960
So the GCC submitted an application actually to the Accreditation
590
00:33:55.359 --> 00:33:59.119
Board of Specialty Nursing Certification all right, which is the
591
00:33:59.440 --> 00:34:04.480
AB the s NC, because the ANC basically does the
592
00:34:04.759 --> 00:34:08.159
entry level which is the IGNP FNP and so the
593
00:34:08.239 --> 00:34:12.440
AB s NC kind of recognizes the specialty level the
594
00:34:12.440 --> 00:34:14.760
top of the paramid if we're looking at the consensus model.
595
00:34:15.039 --> 00:34:16.239
So we submitted that.
596
00:34:17.400 --> 00:34:18.400
Oh, that was.
597
00:34:18.320 --> 00:34:20.559
About a month ago. Two months ago, we had to
598
00:34:20.559 --> 00:34:23.519
write the whole policy handbook, go through the whole entire thing,
599
00:34:24.039 --> 00:34:27.000
and so we've gotten some response. So we're really hoping
600
00:34:27.159 --> 00:34:31.559
that that will, fingers crossed, be complete and that we
601
00:34:31.599 --> 00:34:35.079
will be verified so that we'll be recognized as a truth.
602
00:34:35.239 --> 00:34:38.239
That'll certainly that'll elevate elevate the.
603
00:34:38.599 --> 00:34:40.519
Oh it's got to because I got I know a
604
00:34:40.559 --> 00:34:42.480
lot of people say, well, what's what's in it for me?
605
00:34:42.760 --> 00:34:45.639
I mean, I hate when I hear that question, because
606
00:34:46.400 --> 00:34:48.199
we're in it for the patients and this is better
607
00:34:48.199 --> 00:34:50.960
care for the patients. But I think once we kind
608
00:34:50.960 --> 00:34:55.239
of get that credentialing and we get verified, that true
609
00:34:55.360 --> 00:34:59.039
marketing of yourself and kind of going to your employment
610
00:34:59.079 --> 00:35:02.039
and going to your institut in saying hey, now I'm
611
00:35:02.119 --> 00:35:05.000
an expert in this. You know, being able to advocate
612
00:35:05.039 --> 00:35:07.239
for yourself and for your patients will be a huge part.
613
00:35:08.159 --> 00:35:11.760
It just seems to me a no brainer for organizations
614
00:35:11.800 --> 00:35:17.840
that use nurse practitioners as their primary providers in long
615
00:35:17.920 --> 00:35:21.679
term care setting, for instance, or in assisted living, that
616
00:35:22.000 --> 00:35:25.960
it should be a requirement or a requirement within the
617
00:35:25.960 --> 00:35:28.599
first three years of being hired.
618
00:35:29.000 --> 00:35:31.039
And the research is there. I mean, when you look
619
00:35:31.079 --> 00:35:36.800
at geriatric specialist pathways, the reduction and like even just
620
00:35:36.840 --> 00:35:41.519
in the hospital, having some sort of geriatric specialist pathway
621
00:35:41.599 --> 00:35:45.719
for surgical patients reduces their complications in house by fifty percent,
622
00:35:46.400 --> 00:35:50.679
fifty percent forty percent of delirium is preventable, and.
623
00:35:50.639 --> 00:35:53.480
So and that's the return, that's the return on investments.
624
00:35:53.559 --> 00:35:57.760
You know, it's billions of dollars, billions of dollars that
625
00:35:57.800 --> 00:36:01.280
we spend on delirium and it forty percent is preventable.
626
00:36:01.840 --> 00:36:04.920
And so I think, you know when you argue with that,
627
00:36:05.000 --> 00:36:07.480
and then now you look at the CMS initiatives and
628
00:36:07.480 --> 00:36:09.679
you realize how much they're actually if you don't meet
629
00:36:09.679 --> 00:36:12.880
these standards, they are penalizing you, and they're and and
630
00:36:13.239 --> 00:36:16.239
it's thousands, it's millions of dollars, depending on the size
631
00:36:16.280 --> 00:36:19.079
of your hospital. That in itself is a driver. And
632
00:36:19.440 --> 00:36:22.079
I get that when you're thinking of it from that standpoint,
633
00:36:22.159 --> 00:36:26.880
but the effect that it has for your patients is
634
00:36:27.039 --> 00:36:30.039
just fascinating. Because even now I still get patients that
635
00:36:30.119 --> 00:36:33.199
come in and you know, and they're on medications for
636
00:36:33.280 --> 00:36:36.079
side effects of other medications, and then the list just
637
00:36:36.159 --> 00:36:39.599
keeps going. And so that whole confidence and knowing how
638
00:36:39.639 --> 00:36:43.559
to de prescribe and knowing polypharmacy and knowing you know,
639
00:36:43.639 --> 00:36:46.840
at risk medications, risks and benefits has been a huge,
640
00:36:47.039 --> 00:36:50.199
huge part of my education for my patients.
641
00:36:51.320 --> 00:36:53.920
Excellent, excellent, so what's next for you, your DNP.
642
00:36:54.920 --> 00:36:57.239
You know what, I go back and forth, I really do.
643
00:36:58.400 --> 00:37:02.000
I recently started my own small business for aging in
644
00:37:02.039 --> 00:37:05.039
place in the Lehigh Valley, so I really would like
645
00:37:05.119 --> 00:37:07.159
to see that kind of take off a little bit.
646
00:37:07.199 --> 00:37:09.480
I would still keep this job, but it's more. I
647
00:37:09.519 --> 00:37:13.360
went and got certified actually through age Safe America as
648
00:37:13.400 --> 00:37:16.480
a senior home safety specialist to help with ball reductions,
649
00:37:17.119 --> 00:37:21.840
and so my hope is to kind of stop seeing
650
00:37:21.880 --> 00:37:24.800
them from these falls and kind of help implement different
651
00:37:24.800 --> 00:37:28.559
things in the home for safety rather than seeing them
652
00:37:28.599 --> 00:37:32.519
come in with broken femurs and subdural hematomas and coming
653
00:37:32.559 --> 00:37:34.639
see me in the hospital. So I'm hoping to kind
654
00:37:34.679 --> 00:37:37.840
of get them and help them stay in their homes
655
00:37:37.880 --> 00:37:41.280
longer because nobody can afford nursing homes either. So I'm
656
00:37:41.280 --> 00:37:42.880
not really sure, and we're going to have to wait
657
00:37:42.920 --> 00:37:45.480
to see. But then, but then probably a DNP are
658
00:37:45.519 --> 00:37:48.480
you I can't stop, but your goal is.
659
00:37:48.440 --> 00:37:51.840
To put your orthopedic surgical services out of business when
660
00:37:51.880 --> 00:37:54.519
it comes to geriatric, So you know, to a.
661
00:37:54.440 --> 00:37:56.440
Certain extent, if it means the best for my patient,
662
00:37:56.480 --> 00:37:58.199
you bet, I don't mind at all.
663
00:38:00.639 --> 00:38:04.440
Thank you so much, Christina for your time today. Do
664
00:38:04.480 --> 00:38:07.920
you have any parting thoughts for our audience before we go?
665
00:38:08.840 --> 00:38:12.519
I would just say that, and I know I said
666
00:38:12.519 --> 00:38:16.480
it before about how primary nurse practitioner certification isn't equal
667
00:38:16.599 --> 00:38:19.800
to a specialty certification. And for those of you that
668
00:38:19.920 --> 00:38:24.360
think that, ah, I've got, you know, the expertise in it,
669
00:38:24.519 --> 00:38:26.920
or I've got the experience in it, and that speaks
670
00:38:26.960 --> 00:38:29.559
for itself. Why do I need a couple of letters?
671
00:38:30.039 --> 00:38:34.119
You know? But in this day and age and investing
672
00:38:34.320 --> 00:38:38.960
in yourself and your knowledge, investing in your patients and
673
00:38:39.000 --> 00:38:41.880
their well being cannot be stressed enough. And though it
674
00:38:41.960 --> 00:38:43.679
may just be a couple of extra letters, and I
675
00:38:43.719 --> 00:38:46.639
know we all have alphabet soup after our name, but
676
00:38:46.760 --> 00:38:51.599
I think the turning point and the realization that nursing
677
00:38:51.719 --> 00:38:54.800
is so much more than what we used to think
678
00:38:54.840 --> 00:38:58.320
it was and where we have come, and the amount
679
00:38:58.360 --> 00:39:01.320
of change that we can create and leadership and in
680
00:39:01.519 --> 00:39:06.000
these these roles within organizations, not only at the bedside.
681
00:39:06.000 --> 00:39:09.159
Get we still kind of changing and making these huge,
682
00:39:09.679 --> 00:39:11.960
you know, impacts on our patient lives, but we can
683
00:39:12.039 --> 00:39:15.599
do that also from a higher standpoint. And I think,
684
00:39:15.840 --> 00:39:19.239
you know, just really stressing to never stop learning and
685
00:39:19.280 --> 00:39:21.679
never stop trying to figure out better ways to do
686
00:39:21.760 --> 00:39:25.400
things and safer, more better, you know, quality ways of
687
00:39:25.719 --> 00:39:27.920
kind of improving patient care. That's why we all went
688
00:39:27.960 --> 00:39:30.360
into nursing. And there are so many different kind of
689
00:39:30.440 --> 00:39:33.079
venues and avenues to take to keep that going, and
690
00:39:33.119 --> 00:39:35.280
I think that the GSE is definitely one of those.
691
00:39:36.320 --> 00:39:39.239
Thank you again for your time. This has been wonderful,
692
00:39:39.920 --> 00:39:43.559
and thank you all for being part of our conversation today.
693
00:39:44.079 --> 00:39:47.519
So until our next chat, be kind to each other,
694
00:39:47.719 --> 00:39:50.159
but remember to be kind to yourself.
695
00:39:51.960 --> 00:39:55.480
KAPNA Chat is owned and produced by the Gerontological Advanced
696
00:39:55.519 --> 00:39:59.599
Practice Nurses Association. All rights reserved. No portion of this
697
00:39:59.639 --> 00:40:04.199
podcast may be used without written permission. A Practical Guide
698
00:40:04.239 --> 00:40:08.039
for the Gerontological Specialist is now available for purchase in
699
00:40:08.119 --> 00:40:11.880
the GAPNA store. This text is a handy resource for
700
00:40:11.960 --> 00:40:15.480
anyone caring for older adults and is helpful to those
701
00:40:15.559 --> 00:40:20.639
preparing to sit for the Gerontological Specialist Certified Exam. Visit
702
00:40:20.840 --> 00:40:26.039
www dot GAPNA dot org to get your copy. Christina
703
00:40:26.119 --> 00:40:31.000
Hollub is lead nurse practitioner and Geriatric Surgery Program Coordinator
704
00:40:31.199 --> 00:40:35.280
at the Lehigh Valley Health Network in Allentown, Pennsylvania, and
705
00:40:35.519 --> 00:40:41.400
President Elect of the Gerontological Nursing Certification Commission Board. Notably,
706
00:40:41.639 --> 00:40:46.400
she has also contributed as a GNCC expert in national
707
00:40:46.440 --> 00:40:52.840
Credentialing standard setting for the Gerontological Specialist Certified GSC examination.
708
00:40:54.519 --> 00:40:58.119
Doctor Cassandra von s is the Nurse's Improving Care for
709
00:40:58.280 --> 00:41:04.000
Health System Elders Need Coordinator Geriatric Oncology at the Moffat
710
00:41:04.000 --> 00:41:07.360
Cancer Center in Tampa, Florida. She is a member of
711
00:41:07.400 --> 00:41:12.679
the Gerontological Advanced Practice Nurses Association Communication Team and is
712
00:41:12.719 --> 00:41:17.280
a host of the GAPNA Chat podcast series. For archived
713
00:41:17.320 --> 00:41:20.440
episodes of GAPNA Chat and to learn more about the
714
00:41:20.559 --> 00:41:26.519
Gerontological Advanced Practice Nurses Association, visit GAPNA dot org. You
715
00:41:26.599 --> 00:41:33.719
can also subscribe to GAPNA chat Everywhere podcasts are found