Gerontological Nursing Role Delineation Study

regarded as more critical than the frequency scale. Therefore, the scales were combined so thata particular value on the performance expectation scale would outweigh or outrank all values onthe consequence and frequency scales. This hierarchical scheme emphasized the work activitiesthat are required of newly certified specialists and have the greatest impact on public health orsafety. Thus this scheme was selected as the organizing mechanism for combining theresponses from the three survey scales into an overall measure of criticality.Data CollectionPilot Testing. Using the same procedures intended for administering the national datacollection, the survey was piloted in March and April 2013. Twenty-five ANCC-certifiedgerontological nurses were included in the selection of 125 ANCC-certified nurses randomlyselected from across the nation to take the pilot survey. Overall, 42 (34 percent) of the nursesinvited to take the pilot survey responded (5 from gerontological nursing).National Survey. In May and June 2013, the 1,500 ANCC-certified gerontological nursesselected to take the national web-based survey were sent three notifications via the United StatesPostal Service: an alert letter, and two follow-up reminders. The alert letter explained thepurpose and importance of the study, the eligibility criteria of the study, and stated how to accessthe survey via the internet. The letter indicated that the participant’s responses would be keptconfidential.The letter also notified that respondents completing the survey receive a 5 hour reductionof their continuing education requirement for their ANCC recertification.The first follow-up reminder letter was sent approximately two-weeks after the alert letter.It thanked recipients if they had already submitted their completed survey and encouraged themto do so if they had not already.The final follow-up reminder letter was sent out only to those who had not yet respondedto the survey and was sent out approximately two-weeks prior to the end of the survey.Data AnalysisThe three rating scales were combined into a single measure of overall criticality using ahierarchical method. As agreed by the initial study workgroup, the three rating scales werecombined into a single measure in such a manner that a particular value on the performanceexpectation scale would outweigh or outrank all values on the consequence and frequencyscales, and that a particular value on the consequence scale would outweigh or outrank all valueson the frequency scale.Table 3 displays how the values of the overall criticality rating were constructed accordingto all the possible survey response patterns that might be given to rate an individual work activityby its frequency, performance expectation, and consequence. For example, if a respondentindicated that a particular work activity was expected to be performed within the first six months ofwithin the specialty, could cause severe negative consequences if it was performed incorrectly,and is performed occasionally, the overall criticality rating for that response pattern would be 39.A score of 32 suggests that a work activity is generally expected to be performed within the firstsix months of certification within the specialty and have moderate negative consequences ifincorrectly performed. Therefore, work activities with scores of 32 or higher on the overallcriticality variable may be considered as highly critical. When a work activity was rated as neverexpected on the performance expectation scale, it would receive an overall criticality score of 1 asthe bottom row in Table 3 indicates.2013 Role Delineation Study: Gerontological NursingNational Survey Results Copyright 2014 American Nurses Credentialing Center, All Rights Reserved7

Table 3. Construction of the Overall Criticality VariableSurvey Response OptionsPerformance ExpectationsConsequencesWithin the first 6 months ofcertification within the specialtySevere negativeconsequencesModerate negativeconsequencesMild negativeconsequencesNo negativeconsequencesAfter the first 6 months of certificationwithin the specialtySevere negativeconsequencesModerate negativeconsequencesMild ways11Frequently10Occasionally9Seldom8Never72013 Role Delineation Study: Gerontological NursingNational Survey Results Copyright 2014 American Nurses Credentialing Center, All Rights Reserved8

Table 3. Construction of the Overall Criticality Variable (Continued)Survey Response OptionsPerformance ExpectationsAfter the first 6 months of certificationwithin the specialty (Continued)ConsequencesNo ver expected to perform thisactivity within the specialty2013 Role Delineation Study: Gerontological NursingNational Survey Results1 Copyright 2014 American Nurses Credentialing Center, All Rights Reserved9

Survey ResultsThe total sample size of the national survey included 1,500 ANCC-certified gerontologicalnurses. A total of 472 completed surveys were returned. Thirty-six (36) respondents indicatedthey were not currently practicing in gerontological nursing for an overall response rate of 31.47percent and a usable response rate of 29.78 percent.Table 4 shows the percent of surveys per population returned in each geographic regioncompared to the number of ANCC-certified gerontological nurses selected within the region.Table 4. Number of Surveys Returned per Geographic RegionNumber Selected(Percent of total pop.)Number Returned(percent of total pop.)Northeast – NY, CT, MA, NJ, ME, PA, NH, VT, RI537 (35.80)156 (35.78)South – TN, MS, TX, FL, LA, AL, GA, AR, OK, VA, MD, SC, DC, NC, WV,DE, KY392 (26.13)113 (25.92)399 (26.60)123 (28,21)172 (11.47)44 (10.09)0 (0.00)0 (0.00)1,500 (100.00)436 (100.00)Geographic RegionMidwest – IA, NE, KS, OH, MO, MN, SD, ND, MI, IL, IN, WIWest – WA, AZ, CA, OR, CO, AK, ID, NM, UT, HI, NV, WY, MTOther – AE, AP, APOTotalDemographic InformationAppendix B details the gerontological nurses responses to 15 demographic questionswhich included inquiry on the respondent’s background and practice setting.Demographic BackgroundApproximately 96 percent of the respondents were female and 82 percent reported to bewhite. Approximately 75 percent of the overall sample fell into the age group of 45 to 64 years ofage.Approximately 42 percent of the gerontological nurses indicated that their entry-level(initial) education in Nursing was through an Associate Degree in Nursing program and 32percent indicated it was through a Baccalaureate in Nursing program. Thirty-five percent of thegerontological nurses indicated that they held a Baccalaureate in Nursing as their highest degreein nursing. Approximately 29 percent indicated that they held an Associate Degree in Nursing astheir highest nursing degree and 18 percent of the respondents indicated that they held a Mastersin Nursing.The average number of years of experience the gerontological nurses had as an RN was26 years. The respondents also reported on average 21 years of experience working within thespecialty.Twenty-eight percent of the respondents indicated working as a staff nurse (includingcommunity, clinic, in-patient/client, or other setting, 21 percent indicated working in management.2013 Role Delineation Study: Gerontological NursingNational Survey Results Copyright 2014 American Nurses Credentialing Center, All Rights Reserved10

Practice SettingsApproximately 31 percent of the gerontological nurses indicated that they practice intowns with a population between 2,500 and 49,999, while another 30 percent indicated practicingin cities with a population between 50,000 and 249,999.Thirty-one percent indicating practicing in a long term care facility, while approximately 19percent indicating working in either a medical, surgical, or medical/surgical combined unit. Ninepercent of the respondents indicated working in a home care or home health setting.Fifty-four percent of the respondents indicated they care for patients with chronicconditions while 24 percent indicated caring for patients with acute conditions.Practice DescriptionsDescriptive statistics (means, standard deviations, and medians) for the three ratings ofall 65 work activities—performance expectation, consequence, and frequency—and mean overallcriticality are listed in Appendix C. The scales were highly reliable. Cronbach’s coefficient alphaestimates for the performance expectation, consequence, and frequency scales when applied toall the data were 0.9519, 0.9863, and 0.9635, respectively. (Cronbach's coefficient alpha, ameasure of internal stability, ranges in value between 0 and 1.)In Appendix D, the overall criticality statistics are presented in rank order of criticality.As indicated in Table 5, 17 work activities were rated by the 436 respondents as highly critical(with a mean overall criticality rank of 32 or above).Table 5. Number of Work Activities by Mean Overall Criticality Range and Population for Gerontological NursingMean Overall Criticality ScoreNumber ofWorkActivities37.0 andaboveBetween32.0 and36.9Between27.0 and31.9Between22.0 and26.9Between17.0 and21.9Between12.0 and16.9Between7.0 and11.96.9 andunderTotalnumberabove32.01162776710176Table 6 and 7 displays the 20 highest-ranking and the 20 lowest-ranking work activitiesby mean overall criticality respectively. The grey shading in Table 6 highlights the one task thatreceived a criticality rating of 37 and above –21. Administer medications and other treatmentsthat are appropriate to the patient situation. One work activity received criticality ranking of lessthan 12. This task is highlighted in Table 7.2013 Role Delineation Study: Gerontological NursingNational Survey Results Copyright 2014 American Nurses Credentialing Center, All Rights Reserved11

Table 6. Top 20 Work Activities Ranked by Mean Overall CriticalityWork Activity Number and Name21 Administer medications and other treatments that are appropriate to the patient situation.2 Obtain a current medication and treatment list.22 Respond proactively to changes in patient condition to prevent or minimize adverse patient outcomes.12 Document assessment findings.20 Reconcile medications and treatments across transitions of care.23 Document nursing interventions.32 Advocate for patient.6 Obtain diagnostic test results.4 Perform a physical assessment using age-appropriate, system-specific, evidence-based tools andtechniques.24 Evaluate patient’s response to interventions.11 Identify actual or potential risks to health and safety (e.g., interpersonal, environmental, lack of externalresources).31 Maintain appropriate physical and emotional boundaries.28 Document patient’s response to interventions and changes to the plan of care.17 Create a safe, therapeutic, developmentally appropriate environment conducive to care.33 Document pertinent aspects of nurse-patient interactions.1 Obtain patient history using age-appropriate, system-specific, standardized/evidence-based tools.16 Document plan of care and expected outcomes.5 Perform a psychosocial assessment using age-appropriate, system-specific, evidence-based tools andtechniques.10Identify barriers to effective communication (e.g., psychosocial, literacy, financial, cultural) and makeappropriate adaptations.15 Develop an individualized, patient-centered age and developmentally appropriate plan of care.Table 7. Bottom 20 Work Activities Ranked by Mean Overall CriticalityWork Activity Number and Name55 Coordinate patient safety initiatives.57 Identify and address legal, ethical, and regulatory situations and issues.51 Use technologies to enhance nursing practice38 Incorporate information technology resources into the education plan.3 Assess for use of complementary and alternative healthcare practices (e.g., therapeutic touch, herbalpreparations, acupuncture).8 Synthesize available data and knowledge to identify patterns and variances.48 Serve as a clinical resource.53 Participate in key roles of quality improvement activities63 Collaborate with interdisciplinary team to identify community resources to assist and support patients inself-management.56 Seek opportunities to advance professional nursing practice.49 Mentor colleagues for the advancement of nursing practice, the profession and quality health care.59 Incorporate evidence on population-specific risk behaviors or factors when providing health informationand consumer education.60 Participate in activities that promote partnerships between or among health care providers, employers andcommunities.61 Develop educational programs for individuals.58 Influence healthcare policy involving health care consumers and the profession.54 Participate in key roles related to change management activities.50 Serve as a clinical content expert for the design and enhancement of competencies, policies, procedures,processes, and systems that affect nursing care.64 Coordinate with community resources to provide strategies for health promotion and diseasemanagement.65 Participate in the development of new approaches for care delivery that promote population health.62 Develop educational programs for groups.2013 Role Delineation Study: Gerontological NursingNational Survey Results Copyright 2014 American Nurses Credentialing Center, All Rights ReservedOverall 30.929.34Overall 1.19.8812

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Appendix AWork Activities Statements2013 Role Delineation Study: Gerontological NursingNational Survey Results Copyright 2014 American Nurses Credentialing Center, All Rights Reserved

Domain 1: Assessment and Diagnosis1. Obtain patient history using age-appropriate, system-specific, standardized/evidence-based tools.2. Obtain a current medication and treatment list.3. Assess for use of complementary and alternative healthcare practices (e.g., therapeutic touch, herbal preparations,acupuncture).4. Perform a physical assessment using age-appropriate, system-specific, evidence-based tools and techniques.5. Perform a psychosocial assessment using age-appropriate, system-specific, evidence-based tools and techniques.6. Obtain diagnostic test results.7. Review findings provided by interdisciplinary team and external resources.8. Synthesize available data and knowledge to identify patterns and variances.9. Identify nursing diagnoses using a standardized classification system.10. Identify barriers to effective communication (e.g., psychosocial, literacy, financial, cultural) and make appropriate adaptations.11. Identify actual or potential risks to health and safety (e.g., interpersonal, environmental, lack of external resources).12. Document assessment findings.Domain 2: Planning and Outcomes Identification13. Prioritize nursing diagnoses and/or problems.14. Formulate expected outcomes with the patient, family, significant other, and interdisciplinary team to facilitate continuity acrossthe continuum of care.15. Develop an individualized, patient-centered age and developmentally appropriate plan of care.16. Document plan of care and expected outcomes.Domain 3: Implementation17. Create a safe, therapeutic, developmentally appropriate environment conducive to care.18. Implement age and developmentally appropriate evidence-based nursing interventions specific to the plan of care.19. Collaborate with the interdisciplinary team and external resources to coordinate the plan of care across the continuum.20. Reconcile medications and treatments across transitions of care.21. Administer medications and other treatments that are appropriate to the patient situation.22. Respond proactively to changes in patient condition to prevent or minimize adverse patient outcomes.23. Document nursing interventions.Domain 4: Evaluation24. Evaluate patient’s response to interventions.25. Evaluate the effectiveness of the interdisciplinary plan of care.26. Modify the plan of care in collaboration with patient, family, significant other, and interdisciplinary team based on ongoingassessment data.27. Disseminate results/changes in the plan of care to patient, family, significant other, and interdisciplinary team consistent withpatient preferences.28. Document patient’s response to interventions and changes to the plan of care.Domain 5: Nurse-Patient Relationship29. Develop a therapeutic relationship specific to the patie

specialists, and other disciplines. More than 19,000 candidates took an ANCC certification examination in 2013. In addition to certification, ANCC provides services such as the Magnet and . random sample of 1,500 nurses ANCC board certified in Gerontological Nursing, stratified by region, was selected from the ANCC certification database to .