Adult gerontology primary care nurse practitioners (AGPCNPs) provide primary care services to patients from adolescence on through old age. As individuals progress from early adulthood to middle and old age, they may experience a number of health challenges such as obesity, diabetes, arthritis, hypertension, heart disease, dementia, osteoporosis, and cancer. AGPCNPs play an important role in helping their patients maintain a strong baseline of health, identify risk factors for health problems, and manage existing health conditions in order to avoid severe complications that would require intensive care. AGPCNPs focus on patient education, preventative health care measures such as immunizations and routine check-ups, monitoring of chronic conditions, medication management, and care coordination. They also see patients for mild to moderate health complaints such as the common cold and minor injuries. In certain states, AGPNCPs may also be authorized to independently prescribe medications.
AGPCNPs can work in outpatient care settings such as hospital departments and clinics that either provide internal medicine services or specialized support around a chronic condition such as heart disease, asthma, or gastrointestinal disorders. They can also work in community clinics, long-term and palliative care facilities, and private practices. Depending on their state’s scope of practice regulations, AGPCNPs may also be able to find employment in acute care settings such as emergency departments, where they work with patients who are experiencing conditions that are not life-threatening and which do not require intensive care.
To become an adult-gerontology primary care nurse practitioner, registered nurses must complete a graduate nursing program with a concentration in adult gerontology primary care from an institution that has been accredited by either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). During this program, they must also complete a minimum of 500 hours of clinical practicum in settings that are relevant to adult primary care services. After completing their graduate program, prospective AGPCNPs must pass a certification examination administered by either the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP). After obtaining national certification, prospective AGPCNPs must also research and obtain any state-specific licenses or certifications prior to practicing.
Where AGPCNPs Work
Adult gerontology primary care nurse practitioners work in a wide variety of settings that provide primary care and/or specialized outpatient care to patients from age 13 on through old age. Below is a detailed description of several of the most common settings that employ adult-gerontology primary care nurse practitioners.
Outpatient Clinics in Hospitals
Adult gerontology primary care nurse practitioners can work in outpatient clinics in hospitals, where they may function as a primary care provider alongside internists and family physicians. While they are trained to work with patients ages 13 and over, many AGPCNPs focus on the geriatric population. AGPCNPs can also work in internal medicine, as well as specialized departments that treat adult patients suffering from certain severe and/or chronic conditions, such as asthma, arthritis, diabetes, heart disease, chronic obstructive pulmonary disease, or cancer. They may also work in the palliative care departments of hospitals. In outpatient hospital settings, AGPCNPs typically collaborate with physicians, nurse practitioners, registered nurses, medical assistants, and other medical and administrative staff to coordinate and deliver care.
Unlike adult gerontology acute care nurse practitioners, who generally work to stabilize patients experiencing severe or life-threatening illnesses, injuries, or exacerbations of chronic conditions, AGPCNPs typically work with patients who are in stable condition. The goal of adult-gerontology primary care nursing is to help patients maintain a strong baseline of health to prevent the onset or the progression of conditions that could result in their hospitalization or a visit to the Emergency Department.
Acute Care Departments of Hospitals
While AGPCNPs typically work in outpatient care, depending on how their department is structured and their state’s scope of practice regulations, they may also treat and/or consult with patients in intensive care settings. For example, an AGPCNP who works in the pulmonary department of a hospital may not only see patients in the outpatient clinic for consultations, but also see patients who have been hospitalized for acute asthma reactions. Even when working in acute care settings, AGPCNPs still stay within their scope of practice, in that they do not provide intensive care, but rather help patients to manage their medications, identify their asthma triggers, or transition safely to lower-level care, outpatient care, or home.
Carol Darwin, MSN, AGNP-BC is an adult-gerontology primary care nurse practitioner who works in the Emergency Department at Harrison County Hospital, where she treats patients who are suffering from mild to moderate conditions such as strep throat, minor lacerations, and abdominal pain. “Like most ERs, we use the numerical value system 1-5 to grade the severity of the patient’s problem (1= severe trauma, will die without intervention and 5=no severe threat, strep swabs, etc). The Nurse Practitioner will typically see patients with grades 3-5, leaving the more severe patients to be seen by the physician,” she explained in an interview with OnlineFNPPrograms.com. In addition to managing patients with low-severity conditions, AGPCNPs who work in acute care settings may also provide support to physicians, critical care nurses, and adult-gerontology acute care nurse practitioners. “[I]f there is a severe trauma or code, the NP will assist the physician in any way possible during the code,” Ms. Darwin continued, “ The ER is very much a treat and release scenario. The acute problems are managed, and the patient is either admitted to the hospital for further care or released.”
Long Term, Palliative, and In-Home Care Centers
Several of the most common work settings for AGPCNPs are palliative care, hospice, and long-term care (LTC) facilities, as well as in-home care services that send health care providers to elderly or disabled patients’ homes for primary care house calls and other medical support. Long term care facilities and home-based medical services provide primary care services and monitoring of existing conditions to help patients maintain strong overall health and reduce their chances of experiencing severe negative health outcomes that could result in a hospital visit. Palliative care and hospice care settings focus more on treatments that ease the pain and discomfort of serious medical ailments, such as cancer, heart disease, and kidney failure. Below is a more detailed description of these settings:
- Long Term Care Centers: Also known as nursing homes, assisted living facilities, and skilled nursing facilities, long term care centers provide housing and both medical and personal care services to patients who are unable to live independently due to age, a debilitating disease, or another health condition. These centers also typically provide 24/7 monitoring and support to residents.
- Palliative Care Centers: Palliative care centers are specialized medical centers that focus on providing pain management services and comfort care. Palliative care centers, unlike long-term care centers, can be outpatient settings that provide treatments by appointment to supplement a patient’s overall care plan.
- Hospice Care Centers: Hospice care is for patients with terminal illnesses who have a prognosis of fewer than 6 months to live. Hospice care focuses on comfort care without curative intent, and is usually delivered in a patient’s home or in a nursing home. Hospice care and palliative care are similar in that they both focus on pain management and patient comfort. However, while palliative care generally occurs alongside curative treatment, and can begin at the beginning of a patient’s diagnosis and treatment plan, hospice care is administered after a terminal diagnosis, after curative treatment has stopped.
- Home-Based Medical Services: Home-based medical services involve health care providers such as nurse practitioners, physicians, and medical assistants visiting patients’ homes to assess their health, deliver medical care, and provide counseling and advice on treatment and self-care. This model of care allows patients to remain in the comfort of their home, which can be helpful for patients for whom transportation and mobility are difficult.
Renee Reed, MSN, ANP-C is a nurse practitioner who has worked in a variety of long-term care and palliative care settings. As an Adult-Gerontology Nurse Practitioner at Landmark Health, a home-based medical services company, Ms. Reed provides 24/7 in-home primary care services to elderly patients. In an interview with OnlineFNPPrograms.com, she described the core objectives of the in-home geriatric care model. “The goal of this care model is to manage chronic diseases and keep patients at home for as long as possible, and to get ahead of those triggers that send them to the hospital and emergency room,” she explained, “As an adult/geriatric nurse practitioner, I deliver care to these patients in their home environment, 24 hours a day, seven days a week, day or night, including holidays. We rotate our call coverage amongst providers. It is essentially a concierge medical model, for those patients who can’t exactly afford concierge medicine, but truly benefit from it.”
Prior to her current position at Landmark Health, Ms. Reed worked for United Healthcare/Optum Health, where she served dual-eligible Medicare and Medicaid patients in a long-term post-acute care setting. She explained to OnlineFNPPrograms.com how, at United Healthcare/Optum Health, she rotated between three different nursing care facilities to support patients from underserved communities. “I was assigned dual-eligible patients between three different nursing homes in East Portland. Many of these patients have multiple chronic diseases, including dementia, multiple sclerosis, paraplegia, congestive heart failure, severe depression, immobility, chronic kidney disease, and diabetes,” she said, “These patients had more mental health challenges as well, and we frequently managed their depression, anxiety, and PTSD, for example. They were also of lower socioeconomic status and required a lot of care coordination.”
Private Practices and Group Medical Practices
AGPCNPs can also work in private practices alongside physicians and registered nurses. Private practices are typically outpatient office settings that see patients on a by-appointment basis for regular check-ups or to address mild to moderate health complaints and chronic conditions. Private practices can focus on family or internal medicine, on a particular sector of the adult population (such as the elderly), or on a particular condition or body system (ex. dermatology, pulmonology, allergy testing and treatment, etc.).
AGPCNPs who work in private practices generally have the same responsibilities as they would have in outpatient departments of hospitals, in that they see patients for wellness exams, medication consultations and prescriptions, diagnostic screenings, and other primary care services. In some states, nurse practitioners have prescriptive authority and may have the ability to establish their own private practices or join group private practices.
Specialized Care Facilities
AGPCNPs can also work in non-hospital medical settings that support patients battling a specific type of disease, disorder, or health condition, or which offer a particular type of care. Examples of such facilities include satellite kidney dialysis centers, freestanding asthma and/or allergy clinics, diabetes centers, corporate health care clinics, and other specialized care settings. As they are not typically connected to a hospital that can provide intensive care or emergency services, these specialized care facilities generally only provide patient education, regular checkups or monitoring of a condition, medication guidance and adjustments, and hospital referrals if a patient’s needs require more intensive care.
Some specialized care centers supplement their main in-office medical care with sending contract nurse practitioners to work at medical locations in need of additional staff. Derrick Love-Jones, MSN, AGPCNP-BC is a Nurse Practitioner and CEO of Nephrology Rounding Solutions (NRS), a company that trains Nephrology Nurse Practitioners who serve patients on a contract basis in nephrology clinics and practices. In an interview with OnlineFNPPrograms.com, he described how he and his fellow nurse practitioners at NRS, Inc. travel to satellite kidney dialysis centers, hospital clinics, and private practices to provide nephrology-centered care to patients. “As an AGPCNP at NRS I perform primary care home visits and/or office visits, diagnose and manage acute and chronic conditions, as well as emphasize the importance of health promotion and disease prevention,” he explained.
Specialized care centers can also serve as hubs for research on a given condition and its treatment methods. For example, an asthma center may conduct surveys to evaluate what environmental conditions are contributing to the prevalence of asthma in the community, or a diabetes center may partner with a university to research underlying causes of diabetes and/or new methods of symptom management.
Community health clinics (CHC) provide health care services to vulnerable or underserved populations. CHCs receive federal funding to provide comprehensive primary care to patients who have Medicaid or Medicare, and often implement a sliding scale payment system. In addition to primary care services, some community health clinics may also provide counseling, patient education programs to teach patients about the prevention and treatment of health issues that are prevalent among the medically underserved, and social services.
What Adult-Gerontology Primary Care Nurse Practitioners Do
As mentioned previously, AGPCNPs’ primary mission is to help their patients obtain and maintain a strong baseline of physical and mental health, and to avoid development of conditions that typically afflict adults over the course of their life, such as high cholesterol, arthritis, heart and lung disease, vision problems, and osteoporosis. For patients who are already grappling with chronic conditions, AGPCNPs work with them to develop a plan of care to avoid exacerbations of their disease and to work towards slowing or reversing the disease’s progression. To achieve the aforementioned goals, AGPCNPs use a combination of preventative health care, ongoing treatment of existing conditions, care coordination services, patient education, and emotional support.
AGPCNPs’ patient population differs depending on their work setting–for example, many AGPCNPs work specifically with geriatric patients, while other AGPNCPs may work in a family medicine setting, seeing patients from as young as 13 years old to elderly individuals. Nevertheless, AGPCNPs’ core responsibilities tend to remain fairly consistent across work settings. Below is a more detailed description of the main tasks that AGPCNPs complete on the job.
Wellness Exams and Diagnostic Screenings
One of the most important responsibilities that AGPCNPs have is conducting wellness exams. Also known as annual physical checkups, wellness exams involve conducting an assessment of a patient’s body systems and primary markers of health, taking stock of his or her medical history, evaluating the status of existing medical conditions, and assessing any genetic, environmental or behavioral risks for future health problems. If a patient exhibits symptoms of a disease, or is known to have a genetic predisposition for a particular condition, such as high cholesterol, high blood pressure, diabetes, osteoporosis, cancer, dementia, asthma, and other health issues, AGPCNPs may order additional diagnostic tests.
When conducting physical health assessments, AGPCNPs make note of any environmental, familial, social, financial, emotional, and/or behavioral circumstances that may affect patients’ physical health. For example, AGPCNPs may screen for signs of isolation, depression, or physical or emotional abuse among their patients, and factor in a patient’s socioeconomic circumstances and how easy it may be for them to obtain sufficient treatment for their health problems before developing a plan of care. Adults of all ages can suffer from stressors and health risks unique to their stage in life. Adolescents and young adults generally face very different life events and health challenges than do middle age adults, while the elderly must contend with their own set of challenges as well. AGPCNPs are attuned to the different stages of adulthood and how a patient’s life situation impacts his or her physical and mental well-being. This holistic approach can help them to develop strong ongoing relationships with patients and their families.
Amanda Ruch, MS, AGPCNP-BC is an Adult-Gerontology Nurse Practitioner at Frederick Regional Health System. In an interview with OnlineFNPPrograms.com, she explained the multitude of tasks that comprise a typical wellness exam. “A typical consultation encompasses review of referring and primary care progress notes, diagnostic studies (laboratory, X-Rays, MRI, CT scan, etc.), obtaining a thorough medical and social history, review of systems, performing a complete physical examination, diagnosing and implementing a plan of care, and providing education regarding condition(s)/diagnosis, medication, and diagnostic testing,” she said.
Management and Prevention of Health Conditions
AGPCNPs participate in the ongoing medical care of patients with chronic health conditions by monitoring these conditions over time, prescribing treatments, and developing a patient care plan in collaboration with other medical staff. “[We also complete follow-up visits] for established patients with acute or chronic conditions,” Ms. Ruch continued, “[These visits involve] evaluating the patient’s status, medical and social history; obtaining a pertinent review of systems; and reviewing and evaluating their medication regimen,” she said, “Depending upon the status of the condition, medication adjustments and ordering of diagnostic testing may be warranted. Patient education may also be required for follow up visits.”
AGPCNPs also help patients manage acute conditions that do not require intensive care, but which require treatment so that they do not worsen. In her interview, Ms. Reed explained how her role requires her to respond to patients’ acute care needs, ranging from infections to allergic reactions. “On a typical day, we will respond to urgent visits in the patients’ home,” she said, “We typically see patients urgently for symptoms of infection, and can initiate IV fluids and antibiotics in the home if needed to ‘get ahead’ of infections that may become worse and turn into an Emergency Department visit or admission to the hospital.” Preventative treatments such as immunizations are another important part of AGPCNPs’ daily work with patients. AGPCNPs can administer vaccines to prevent the flu, tetanus, HPV, Hepatitis, and other infections that adults are at risk of contracting.
AGPCNPs also educate patients about strategies to prevent and/or manage health conditions such as overweight, obesity, asthma, and diabetes. Lifestyle changes can be some of the most important measures a patient can take to prevent and treat harmful health conditions. As mentioned previously, AGPCNPs take a holistic approach to patient health by taking into account the familial, social, spiritual, financial, and behavioral issues that could affect a patient’s health and wellness. They use this information to advise patients on ways in which they can address their health concerns through a healthy daily regimen and by accessing resources in their community.
AGPCNPs play an important role in care coordination, ensuring that patients receive timely and consistent medical support when they need it. As part of a larger team of healthcare providers, AGPCNPs meet regularly with physicians, registered nurses, physician assistants, medical assistants, and social workers to develop, implement, and continually modify a patient’s plan of care. “We, as a provider team, hold weekly Interdisciplinary Team (IDT) meetings where we each review our previous week’s visits, discuss those cases that have resulted in sentinel events (hospitalizations, ED visits, etc), and review where we may have had more of an impact in avoiding these [inpatient] admissions,” Ms. Reed said, “[B]ecause our patients are chronically ill and complex, we all benefit from discussing the cases and seeking input from the various team members, from mental health providers to our case workers.”
AGPCNPs also help their elderly patients navigate palliative care and end-of-life concerns. “I would also assist residents, their families, and nursing staff with palliative care and advanced care planning. I would assist in transferring patients to Hospice programs, and prepare the patients to discharge to home,” Ms. Reed continued.
Adult-gerontology primary care nurse practitioners advocate for the well-being of their patients in several ways. On a patient-by-patient basis, AGPCNPs try to determine when their patients are in need of additional support, such as when they are victims of abuse, are struggling to afford the medications they need, or are suffering from behavioral or emotional problems that affect their physical health. For example, elderly patients are at times at risk of financial exploitation and hardship, social isolation, and other factors that can negatively impact their emotional and physical well-being. AGPCNPs can connect these patients to counseling, financial assistance, and community resources that can support them and help them to manage these issues.
During her work at Landmark Health, Ms. Reed serves as an advocate for both her patients and their families, and helps to ensure that they receive the type and degree of care that they require. “I advocate for my patients as they work with their primary care provider and specialists, as well as other members of the healthcare team,” she said, “I am able to collaborate with ancillary staff such as physical therapy, mental health, dieticians, case workers and care managers to better coordinate patient care and achieve positive outcomes, both large and small.” Ms. Reed also works with her patients to help them develop an end-of-life plan that they are comfortable with. “I am able to advocate a patient’s wishes at end-of-life, and help them to die with dignity and as they wish, not how others feel they should,” she said.
Staff Leadership, Research, and Program Development
AGPCNPs can also participate in research by working with a medical university or collaborating with medical research institutions that investigate a particular type of condition, such as food allergies, asthma, diabetes, or heart disease. Nurse practitioners who are interested in research can connect with professional nursing organizations, such as the American Association of Nurse Practitioners Network for Research (AANPNR), to find opportunities in their area.
Adult-gerontology primary care nurse practitioners can also take on administrative leadership roles. For example, AGPCNPs in a hospital setting can participate in training staff or conducting surveys of medical personnel and patients in order to see where the hospital’s systems of care could use improvement, and what units need updated medical equipment or additional staff support. AGPCNPs can also help to develop programs to improve medical care in their work setting–for example, staff training programs, patient education programs, and/or initiatives that work to streamline communication between different medical providers.
Nurse practitioners who have established their own private practice or medical care company also complete administrative leadership responsibilities as part of running their business. For example, Mr. Love-Jones, as CEO of Nephrology Rounding Solutions, participates in the training of the AGPCNPs whom he hires, manages the operations of several primary care clinics, and also organizes the delivery of medical services to the patients at the facilities NRS serves. “[As] CEO of NRS, I oversee the day-to-day operations of the company, as well as the primary care outpatient clinics we operate,” he told OnlineFNPPrograms.com.
AGPCNPs can also teach courses at nursing schools on such topics as health assessments, treating geriatric patients, and other subjects that are relevant to adult-gerontology primary care nursing. AGPCNPs can take on part-time faculty positions, or engage in one-time seminars hosted by a university. For example, Ms. Ruch explained in her interview with OnlineFNPPrograms.com how she provided a lecture for a series hosted by Johns Hopkins University. “I was asked to present a class through the Odyssey Series, which is part of the Mini-Medical School Program at Johns Hopkins University,” she said, “The class is entitled ‘Managing the Medical Needs in a Geriatric Patient.’” Teaching courses or hosting seminars for nursing students and staff can be a rewarding part-time commitment for AGPCNPs who enjoy instructing others in effective nursing methods and concepts.
The Challenges and Rewards of Adult-Gerontology Primary Care Nursing
Working in advanced practice adult-gerontology primary care nursing can be very challenging due to the complexity of the health conditions that adult patients can face, as well as the barriers that patients encounter when trying to access adequate health care services. Helping patients navigate a complex health care system and receive health insurance benefits can be a very challenging part of AGPCNPs’ daily work. “My veteran patients will wait months for appointments; obtaining their records is daunting. Just ordering a walker, or in-home care for patients discharging from care homes can be like climbing Mount Everest,” Ms. Reed said of her work with geriatric patients, “Some days you want to go buy a bedside commode personally to avoid the red tape that comes with submitting it to insurance or Medicare. There may be a perfect medication for a patient but due to cost, it’s not truly an option.”
Organizing, implementing, and updating the primary care plan for adults with chronic conditions such as diabetes, heart disease, osteoporosis, chronic pulmonary obstructive disease, and other ailments can also be challenging due to the many parties involved in a given patient’s health care plan. “Care is [often] very fragmented for chronically ill geriatric patients, particularly in the nursing home setting,” Ms. Reed continued, “Trying to coordinate between specialists and primary care physicians who may or may not appreciate your involvement creates roadblocks for these patients.”
Effective communication with patients and with patients’ families can also prove difficult, especially when AGPCNPs are supporting patients who struggle to communicate their needs. “Providing care to demented patients, you have to rely on your assessment skills since these patients cannot fully participate in their review of systems and history of present illness,” Ms. Ruch said, “Dealing with personalities of patients and families brings about its own set of challenges, especially when both parties are very strained, as emotions can run high and make effective communication difficult. It is important to focus on the patient outcome and be empathetic.”
Despite its challenges, advanced practice adult-gerontology primary care nursing can be a rewarding field for registered nurses who enjoy working with adults in primary care settings and helping them to maintain their health as they mature and encounter various health challenges. Effective primary care throughout an adult’s lifespan is essential in preventing acute disease and exacerbations of existing conditions that could be dangerous and costly to patients. For example, the work that AGPCNPs do to advise patients about bone health or blood sugar management can be instrumental in helping patients avoid a devastating hip fracture or a debilitating diabetes diagnosis. While acute care is essential in addressing life-threatening illness and injury, primary care is the foundation of effective health care.
In many ways, preventative measures such as a healthy lifestyle, regular physical checkups, preventative treatments, and patient education at the earliest onset of a condition (ex. dietary changes at the onset of type 2 diabetes, medication and a healthier routine to address high cholesterol and heart disease risks) are more important, more impactful, and significantly less costly than intensive care administered when a condition has reached severe levels. AGPCNPs can find the gradual yet dramatic impact they have on their patients’ overall well-being to be very rewarding, particularly when their role allows them to establish a long-term relationship with their patients.
Though they work in primary care, AGPCNPs can help patients suffering from serious conditions who are in need of long-term care, mental/emotional support, and ongoing care coordination in between their stays in the hospital. During her time working as an adult-gerontology primary care nurse practitioner at United Healthcare/Optum Health, Renee Reed worked closely with patients residing in nursing homes who were suffering from multiple serious health conditions. Though her work was challenging due to the complexity and severity of the conditions her patients encountered, Ms. Reed found her work to be rewarding for the impact she had on their mental and emotional well-being, and for the relationships she built with each of her patients. “[My patients’] medical problems were quite challenging to manage. They were also high utilizers of the emergency room and had higher hospitalization rates,” she said, “They required frequent visits and monitoring to help reduce the number of hospital readmissions. These patients were perhaps the most rewarding to assist; they desperately needed more monitoring and attention, and ‘touches’ from a provider.”
Giving conventionally marginalized populations a voice and the opportunity to express their feelings and concerns is another rewarding aspect of AGPNCPs’ work. “[At times, patients will tell you] that you are one of the first providers to actually listen and value their input, feelings, and thoughts,” Ms. Ruch said of her daily interactions with geriatric patients. Advocating for underserved and vulnerable patient populations, connecting with them, and hearing their stories can be an incredibly fulfilling and energizing aspect of AGPNCPs’ work.
Advice for Registered Nurses Interested in Becoming AGPCNPs
Registered nurses who are interested in becoming adult-gerontology primary care nurse practitioners must complete a graduate nursing program with a concentration in adult primary care nursing from an institution that has been accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission on Education in Nursing (ACEN). As part of this program, students must also fulfill a minimum of 500 hours of clinical practicum in settings that are relevant to adult-gerontology primary nursing care, such as nursing homes, outpatient hospital clinics, hospice centers, and palliative care centers. Once they have fulfilled their educational and clinical practicum requirements, AGPCNPs must pass a national certification examination administered by either the American Nurses Credentialing Center (ANCC) or the American Academy of Nurse Practitioners (AANP), and also fulfill any APRN certifications or credentials required by their state of residence.
In addition to their academic and clinical preparation through an accredited graduate nursing program, AGPCNPs should seek to gain as much experience as possible in different areas of nursing in order to understand how different parts of the health care system work to ensure patient health. As adult-gerontology primary care nursing is a broad field that encompasses many age groups and health conditions, registered nurses interested in entering this field will benefit from having experience in many different settings, and seeking volunteer opportunities for additional medical experience. In her interview, Ms. Darwin advised prospective AGPCNPs to try many different roles within nursing in order to determine what areas of advanced practice nursing interest them. “I would really advise nursing students to broaden their horizons and try as many nursing positions as they can before becoming a NP,” she said.
Ms. Reed similarly recommended that students seek a broad range of experiences, and to try and prioritize variety during their practicums and other clinical experiences. “A very well-rounded clinical rotation is recommended. I struggled to patch together a long-term internship as an NP student. This was a mixed blessing. I got creative and did shorter rotations in several different areas that are commonly seen with geriatrics: oncology, ophthalmology, dermatology, urology, orthopedics, rheumatology, hospice, diabetes management and education, and long-term care,” she said, “I would strongly recommend a part-time job in a nursing home, as a medication aide, nurse assistant, or care manager. Doing many areas helped me to prepare for the issues I see in geriatrics daily.”
As AGPCNPs are often required to take on more staff leadership and care coordination responsibilities, registered nurses interested in this field should also work to develop a very strong understanding of hospital-based systems of care and how different health care providers must collaborate to provide care to patients. AGPCNPs should also connect with their larger care team so that they have a strong support system in the workplace. The interdisciplinary nature of advanced practice adult gerontology primary nursing care, and the complexity of both patient conditions and the health care system in general, mean that AGPCNPs must communicate seamlessly with multiple health providers, as well as insurance companies, nursing homes, and other organizations.
In her interview, Ms. Darwin explained the importance of understanding all the moving pieces of a hospital’s workflow. “I think it is very important to have a broad understanding and respect of how the hospital system works together before becoming an advanced practice nurse,” she said, “I have worked in many different positions in the hospital, which has really provided me with the respect required to do my job properly.” She also advised that AGPNCPs make connections with and seek the support of people in their work setting who are outside of their health care team, and even assume multiple roles in a hospital setting prior to enrolling in a graduate nursing program, in order to develop an appreciation for every hospital staff person’s role in the delivery of care. “There is no better way to understand how hard someone’s job really is besides doing it yourself. I know how tiring it can be to be a nursing assistant and how behind you can become so easily as the unit secretary, so I know how much to value their assistance,” she said, “It is vital to respect everyone, not just whom you consider your equals or superiors.”
Once they have earned their requisite certifications and begun work as AGPCNPs, individuals should continually seek to learn more about the latest developments in primary care nursing methods, and to refresh their understanding of core nursing principles as needed, which can help them quickly navigate difficult patient situations. In her interview with OnlineFNPPrograms.com, Ms. Reed advised, “A solid understanding of chronic illness and pathophysiology is a must. While I feel I have a fairly good grasp, I am still going back for more reviews and to better understand advanced pathophysiology and the managing of multiple chronic illnesses.”
Mr. Love-Jones similarly recommended that practicing AGPCNPs never view the process of learning as finished upon the completion of their graduate degree program. Instead, he encourages his peers to view every day as an opportunity for learning, for sharpening existing skills and learning new ways of approaching a patient problem. “The best advice I was given, was always go back at the end of your clinical day and review anything you did not understand. Understanding the patient issues during your clinical rotation will help you when you begin practice,” he said, “Gain as much knowledge about your new chosen career or specialty as you can, and never stop searching for new information. Always stay up to date with new processes and never stop learning.”
As primary care providers who focus on preventative and ongoing care, AGPCNPs have the power to set their patients on the right course for health and wellness, and to overcome seemingly insurmountable health barriers. “By far, the most rewarding part of my career is affecting my patients’ lives every day in a positive manner, which in turn affects their health outcomes,” Mr. Love-Jones said, “Every day NRS Nurse Practitioners educate their patients on how to apply self-management skills that increase self-awareness, which improves their overall health. The look on a patient’s face when they see the improvement in their labs, or when they are not short of breath because of something that they have learned through NRS’ services, is priceless.” Through diligent academic and clinical preparation, a strong professional support system, and receptivity to constantly learning on the job, AGPCNPs can build rewarding and impactful careers that offer constant opportunities for personal and professional growth.