Terry Fulmer, PhD, RN, FAAN, AGSF
President, The John A. Hartford Foundation
University Distinguished Professor and Dean
Bouve College of Health Sciences, Northeastern University

The field of geriatrics relies on so many different healthcare professionals to provide expert, high-quality, patient-centered care for older adults. In honor of National Nurses Week 2015 (May 6-12), we’re celebrating the commitment of nurses committed to elder care by helping them share their stories in their own words. Here’s what Terry Fulmer—the new president of The John A. Hartford Foundation and a professor of Public Policy and Urban Affairs at Northeastern University—had to say about her career as a gerontological nurse practitioner.

It was her first experience as a nurse that convinced Terry Fulmer the best part of nursing was caring for older patients. Fresh from Skidmore College, where she earned her BS in Clinical Nursing in 1975, Dr. Fulmer had just started working as a staff nurse at Boston’s Beth Israel Hospital, one of Harvard’s teaching hospitals.

“I discovered in the midst of this remarkable teaching hospital that I had this incredible autonomy and authority when working with the older patients,” says Dr. Fulmer, whose mother was a nurse and who decided (at age five) that no other profession could possibly be more exciting or satisfying. “Older adults often need help with activities of daily living, and when they’re very ill, they often need help with geriatric syndromes such as incontinence, confusion, and falls, and that’s all in the domain of nursing care,” she continues. “A physician might diagnose those problems but it’s the nursing practice that creates a care plan to address them. With older patients, the most important component of care, by far, is nursing care. It’s very motivating.”

After recognizing that geriatric nursing was for her, Dr. Fulmer’s first step was to go back to school. While working at Beth Israel, she earned her Master’s degree at Boston College and started her doctorate. Before she’d even finished her PhD she was offered and accepted a position as assistant professor of nursing at the college, where she both taught and began doing research into the detection and prevention of elder abuse and neglect. Dr. Fulmer, who was soon promoted to associate professor, also headed the Beth Israel Hospital Elder Abuse Committee.

Elder abuse remains a focus of Dr. Fulmer’s research and is among several areas in which her work has had considerable impact. In addition to publishing scores of papers, sitting on key panels, and training healthcare professionals to detect abuse and neglect, Dr. Fulmer also played a key role in the development of the Elder Assessment Instrument, a screening checklist now used nationwide.

“I’ve had families call and say that because of our work in this area, they recognized elder abuse in their families,” says Dr. Fulmer. “I’ve also had nurses tell me they’ve been able to help patients because of our work. And I’ve heard from promising young scientists in nursing, medicine and other disciplines that they’ve been impressed by the work and want to carry it on. That’s even better.”

Along with clinical care and research, teaching and training have always been Dr. Fulmer’s passions. “Working with students, every day there’s an ‘Aha!’ moment when they know they’re improving the quality of life for their patients,” Dr. Fulmer says. “You might show a student nurse how to provide excellent mouth care for an older adult who, as a result, is able to eat more nutritiously. It’s amazing. All of a sudden there’s this profound moment when you help them understand how pivotal their work is.”

“You know, I have the same passion today that I had when I started,” adds Dr. Fulmer.” I can’t imagine anything I’d rather do than care for older patients and teach others to do the same.”

Phyllis J. Atkinson, RN, MS, GNP-BC, WCC
Gerontological Nurse Practitioner

The field of geriatrics relies on so many different healthcare professionals to provide expert, high-quality, patient-centered care for older adults. In honor of National Nurses Week 2015 (May 6-12), we’re celebrating the commitment of nurses committed to elder care by helping them share their stories in their own words. Here’s what Phyllis J. Atkinson had to say about her career as a gerontological nurse practitioner.

Phyllis Atkinson remembers, vividly, the day she started rethinking her career in nursing. A critical care nurse, Atkinson was working at a small hospital in Ohio at the time. One morning, an elderly man was admitted to the Intensive Care Unit. He was very frail and gravely ill.

Though it was clear that the man didn’t want invasive procedures or treatments—he resisted with the last of his strength—the ICU team followed protocol and proceeded to restrain and treat him.

“We did all these invasive things to this gentleman, who eventually died,” Atkinson recalls. “I witnessed how he died: It was a death with literally no dignity. And I realized there was something we didn’t understand, something that we could be doing differently to provide him and others like him with more dignity at the end of their lives. I also realized that I wanted to know how older people differ from younger people, and that I wanted to be an advocate for them.”

That realization ultimately led Atkinson to become a geriatric nurse practitioner, a GNP.

Growing up in northwestern Ohio, Atkinson planned on a career in medicine right from the start. She was the kind of kid who asked for chemistry sets for Christmas and caught and dissected frogs to teach herself anatomy. After finishing high school, she completed a three-year nursing diploma program at Toledo Hospital School of Nursing. To become a GNP, she then had to earn her Bachelor’s in Nursing, and then her Master’s. She did both at Ohio State University . Meanwhile, she continued working in hospital ICUs while she and her husband raised their son and daughter. In 1993, she was one of the first to graduate from Ohio State’s newly established GNP program.

Drawn to critical care because of the highly demanding nature of the work, Atkinson found geriatrics even more demanding—and satisfying.

“Geriatrics is more challenging than critical care for a number of reasons,” says Atkinson, 48, who now manages a team of 10 nurse practitioners caring for older adults in nursing homes in the Cincinnati area. She’s is a part-time adjunct professor at Northern Kentucky University, where she teaches geriatrics to nursing students. Among other things, older adults often have multiple, chronic health problems, which makes their care more complex, she says. In addition, geriatrics emphasizes the importance of collaborating closely with the patient—to ensure that his or her treatment isn’t only effective, but that it’s also what he or she wants.

Despite the coming Age Boom, interest in GNP programs lags in part because many universities discourage NPs from specializing, lest this limit their marketability, Atkinson says. Students’ misconceptions about geriatrics also play a role, she adds. “They think it’s not going to be challenging, so I tell them that I know from experience that this is even more challenging than critical care,” she adds.

Looking back at her career in geriatric nursing, Atkinson says she has no regrets about switching from critical care. She offers an anecdote to illustrate why. The anecdote is also about an older adult at the end of life, but it differs dramatically from her experience with the elderly man whose death marked a turning point in her career.

“We had this one patient who was in end-stage dementia,” says Atkinson. “She had severe complications from diabetes and one of her physicians recommended bilateral amputations of her extremities. But her family decided they didn’t want to hospitalize or amputate, but to focus on palliative comfort care instead. So we worked with them to reassure them that they knew what was best for her. We had multiple meetings; we called them almost daily until she died. I can’t tell you how rewarding it was to support them in making decisions that focused on the quality of this woman’s life at the end of her life.”

Until a wealthy young woman named Florence Nightingale entered the profession in the mid-1800s, nursing got very little attention—very few prominent women would even consider nursing as an appropriate career choice (and male nurses were even rarer). Thanks to Nightingale’s pioneering and courageous efforts, especially during the Crimean War (she revolutionized the care of soldiers by instituting hygienic practices), we began to recognize nurses for the essential, invaluable roles they play in health and care for all.

In honor of Nurse Nightingale, we first celebrated National Nurses Week in 1954, on the 100th anniversary of Nightingale’s Crimean Mission, though it took a presidential proclamation nearly 25 years later to recognize the week officially.

HealthinAging.com is particularly delighted this week to salute the hardworking, dedicated nurses who specialize in caring for our older adults. Their mission is an especially essential one as our population ages because of the complex challenges and opportunities so many older adults will face and the role nurses play in making them less daunting and more manageable.

Geriatric and advanced practice nurses serve in many different kinds of settings—hospitals, long-term care or rehabilitation facilities, senior centers, retirement communities, managed care organizations, and public health agencies, as well as in patients’ homes. Often, nurses work as part of a treatment team that includes several other healthcare professionals. Those with master’s degrees from nurse practitioner programs can diagnose and treat both acute and chronic illnesses, and in most states they can prescribe medications, too.

Geriatric and advanced practice nurses will work with older adults to:

• Assess their mental status and thinking skills;
• Understand and help manage acute and chronic health issues;
• Discuss common health concerns, including falls, incontinence, sleep and sexual issues;
• Organize medications;
• Explain personal safety and disease prevention;
• Help them understand and stick to their medication regimen; and
• Achieve a healthy diet, among many other responsibilities.

During National Nurses Week—and all year long—we’re glad to have the opportunity to honor the contributions these talented and caring professionals make to the lives of older adults and their loved ones.