What's Stopping a Career in Gerontological Nursing?

What’s Stopping a Career in Gerontological Nursing? Literature Review ABSTRACT Despite the rapid aging of the world’s population, many countries are experiencing difficulty in recruiting nurses to work with older people. A literature review was conducted regarding the career preferences of undergraduate nursing students from seven dif- ferent countries. The literature review has identified that gerontological nursing does not feature highly as a career goal. Nota- bly, this has been the situation for the past decade. There is no indication that the situation is going to change at any time in the future unless some serious decisions are made at professional, health service, community, and government levels. This literature review has identified the reasons why undergraduate nurses are not choosing gerontological nursing as a career, what has been done in an attempt to address the problem, and what else may be done. [Journal of Gerontological Nursing, xx(x), xx-xx.]

he rapid aging of the world’s population means that the proportion of people ages 60 and older Twill increase from 11% to 22% between 2000 and 2050 (World Health Organization, 2012). In the United States, 41.4 million people are 65 and older, with 24.7% of these individuals rating their health as “fair” or “poor” (Centers for Disease Control and Prevention, 2011). Fur- thermore, 1.3 million of these people live in long-term care (LTC) facilities. The situation is similar in countries with smaller populations such as Australia, where 185,482 older Australians lived in LTC facilities as of June 2011 (Australian Institute of Health and Welfare, 2012). There is concern that the growing population of older adults with associated complex health needs will outpace the number of health workers, such as nurses, with the necessary education and skill to provide competent care (Institute of Medicine [IOM], 2008). As a response to the Francis inquiry of older adult care in the United King- dom (The Mid Staffordshire NHS Foundation Trust, Christine Neville, PhD, RN, FACMHN; Robyn Dickie, RN, BN, McritCN; and Sandra Goetz, RN, MHlthSc, MRCNA

Journal of Gerontological Nursing • Vol. xx, No. xx, 20xx 1 TABLE 1 STRATEGY FOR LITERATURE SEARCH AND PROCESS OF REJECTION AND ACCEPTANCE OF ARTICLES FOR INCLUSION IN THE LITERATURE REVIEW N Articles Articles Articles Articles that Remaining After Remaining After Retrieved and Fit Inclusion Database Total Articles Title Review Abstract Review Examined Criteria CINAHL 151 15 7 3 1 Medline OVID 74 11 11 11 3 PubMed 168 24 19 13 5 PsycINFO 0 0 0 0 0 Manual search 0 0 0 0 3 Total 393 50 37 27 12

Note. 13 duplicate articles were removed.

2013), The National Health Service, Xiao, 2012; Stevens, 2011; Williams, on LTC facilities given the current together with the Royal College Nowak, & Scobee, 2006). Career employment shortage of nurses in of Physicians, have developed an preferences are often made during this sector. Yielded and reviewed ar- Elder Friendly Ward Quality Mark the time spent as an undergraduate ticles are detailed in Table 1. All au- scheme to recognize the importance student, with many factors influ- thors were involved in the literature of and requirement for competent encing the decision. The aim of this search, study selection, and data ex- health workers to care for older literature review was to examine the traction. Inclusion criteria were both adults (Royal College of Physi- responses of undergraduate nursing qualitative and quantitative studies cians, 2013). Nursing, as one of the students from around the world to- that examined what specialty un- predominant health disciplines, has ward a career in gerontological nurs- dergraduate nursing students were a distinct and important role in ger- ing, the reasons why they are not interested in. Studies were excluded ontology because older adults have choosing gerontology as a graduate if they focused on perceptions or a greater number of hospitalization specialty, what has been done in an attitudes toward older adults gen- days (Gilje, Lacey, & Moore, 2007) attempt to address the problem, and erally as opposed to working with and use the largest portion of health what else may be done. older adults. The authors conducted services (IOM, 2008). The Eldercare a manual search of the reference lists Workforce Alliance (n.d.) stated that METHOD of the 27 retrieved articles to deter- by 2020, the gerontological nursing The search strategy involved mine whether other relevant articles workforce is expected to be 20% be- peer-reviewed, English language, re- fit the inclusion criteria. Three suit- low the projected requirements. Such search studies (2003–current). Data- able studies were extracted using the an alarming projection is a reflection bases included Medline, CINAHL, reference list manual search as out- of the global shortage of nurses (Au- PsycINFO, and PubMed. The lined in Table 1. No other literature erbach, Staiger, Muench, & Buer- search syntax and limiters were aged reviews were found. haus, 2013). However, gerontology care OR nursing homes OR care is at particular risk of RN shortage homes OR residential aged care facil- RESULTS because a career in gerontological ities OR long term care; older adults Two categories of results were nursing is not a desirable option, as OR elders OR elderly OR geriatric* identified: studies that surveyed ca- indicated by undergraduate nursing OR older people; and undergradu- reer preferences and studies that students (Abbey et al., 2006; Bosco, ate nurse OR nursing student OR examined career preferences as an Ward, & Styles, 2005; DeKeyser career OR employment OR jobs. It outcome of a curriculum activity. In Ganz & Kahana, 2006; Henderson, is acknowledged by the authors that most studies, the students provided Xiao, Siegloff, Kelton, & Paterson, students do encounter older people reasons as to why they had limited or 2008; Kloster, Høie, & Skår, 2007; in other parts of the health care sys- no interest in gerontological nursing. McCann, Clark, & Lu, 2010; Shen & tem; however, it was decided to focus The student perspective is important

TABLE 2 STUDIES OF UNDERGRADUATE NURSING STUDENT CAREER PREFERENCES of

G N (Year of Reasons for

erontological Study Country Purpose Method Tool Study) Results Non-Preference Surveys of Career Preferences Shen & Xiao (2012) China Explored factors Cross-sectional Questionnaire 204 (1st year) Working with older Uninspiring career; affecting intention (Stevens & Crouch, 218 (2nd year) adults ranked as lack of confidence to work with older 1998) 123 (3rd year) second to least with older adults; adults. 77 (4th year) preferred area. not technical enough; low pay N

ursing Rejeh, Heravi- Iran Explored perspec- Qualitative Semi-structured 25 (senior nursing Established two Time constraints; Karimooi, & Vais- tives regarding interviews students) sub-themes: task oriented; poor moradi (2011) caring for older barriers and nurse-patient adults. facilitators to care ratios; too many •V for older adults. organizational ol rules; poor environ-

. mental conditions xx

, N Stevens (2011) Australia Developed a Longitudinal, Questionnaire 150 (year not Gerontological Negative stereo- profile of career repeated measures (Stevens & Crouch, identified) nursing ranked types; poor clinical o

. preferences and 1998) poorly over 3 placement experi- xx rationales. years, with de- ences; poor work- , 20 creasing interest ing conditions; not

xx from first year. technical enough McCann, Clark, & Australia Surveyed career Longitudinal Attitudes and be- 90 (1st year) Gerontological Media and lay Lu (2010) preference for liefs about mental 46 (2nd year) nursing ranked image poorly specialty areas. health problems: 96 (3rd year) consistently over presented; limited Professional and 3 years as least theoretical and Public Views ques- preferred career clinical experience tionnaire (Jorm, choice. with older adults; Korten, Jacomb, limited contact Christensen, & with gerontologi- Henderson, 1999) cal academics Henderson, Xiao, Australia Explored the inten- Cross-sectional Questionnaire 262 (1st year) Gerontological Lack of inter- Siegloff, Kelton, & tions for practice (Stevens & Crouch, nursing least pre- est; physically Paterson (2008) and attitudes to- 1998) ferred work option; demanding; fear ward older adults. those with previ- of suffering and ous experience in dying; negative the industry more experiences and likely to want a interactions with career in geronto- older adults logical nursing. 3 and we have collated this information (Table 2). Additionally, Table 2 presents other information (e.g., - purpose, methods, findings) to aid in an overall critique of the studies. Reasons for Reasons for Non-Preference Not challeng ing; boring; heavy workload; lacked resources; staff inadequate unqualified levels; workers Not interesting; lacked prestige No variety; not not challenging; entertaining Surveys of Career Preferences - - In 2011, Stevens found that career preferences had differed little from the results of an ear-

lier study in which gerontologi- Results cal nursing rated poorly (Stevens, 1995). This result is echoed in the Gerontological Gerontological nursing ranked poorly as a prefer future for ence both the at work and beginning end of studies and 2nd as a ranked did students place work to not want the end of their at studies. Gerontological nursing recognized as a high social but ranked need, last in categories, in social prestige, and choice terest, of workplace. chose No students gerontological nursing as a career preference. other studies presented in this literature review (Table 2). Bosco et al. (2005) allowed students to depict their growth in care of older Study) (Year of (Year adults from the commencement N of their studies to present, by

620 (1st year) 620 (1st year) year) 473 (3rd & 4th 3rd, 178 (1st, years) year) 25 (3rd drawing a picture and answering survey questions. Results indicated that students underestimated the knowledge required to be an RN and recommendations were Tool that the role of the gerontological RN needed to be recognized Study-specific Study-specific questionnaire Study-specific questionnaire Study-specific and questionnaire artwork depict to in the care growth of older adults and promoted. In a replication of the study by Henderson et al. (2008), Shen and Xiao (2012) found similar results in that those

students with experience in caring Method for older adults were more likely to demonstrate an interest in this Longitudinal Longitudinal Cross-sectional, method mixed area. The process of aging was also explored, with the majority of students interested in the treat-

ment of chronic diseases associated with aging rather than taking Purpose a holistic view of the person in the

Identified career career Identified preferences. Determined the of perceptions nursing students specialties toward factorsand what these. influence Determined the and influences of motivations selecting a nursing path. career context of their social environ- ment. McCann et al. (2010) found that only 1% of students in Year 1, 2% in Year 2, and 0% in Year

Country 3 wanted a career in gerontological nursing. This was explained by Norway Israel Australia the authors as the negative influence of the media, poor quality clinical placements, and discour- (CONTINUED) aging contact with their student peers, new graduates, and other RNs. Curricula lacking in theo- TABLE 2 TABLE retical and clinical content and a STUDIES OF UNDERGRADUATE NURSING STUDENT CAREER PREFERENCES STUDENT NURSING UNDERGRADUATE OF STUDIES Study & Høie, Kloster, Skår (2007) GanzDeKeyser & Kahana (2006) & Ward, Bosco, Styles (2005) lack of suitably experienced ge-

G Study Country Purpose Method Tool Study) Results Non-Preference erontological Innovative Curriculum Activities Brown, Nolan, & United Kingdom Explored the Longitudinal, Focus groups, 718 (differing Students respond Poor mentorship Davies (2008) way students mixed method study-specific points) positively to aged and leadership; experience clinical questionnaire care if they are lack of educational placements (acute well prepared for opportunities; and long term) and the placement; poor working identified charac- are able to make conditions N teristics that create links from theory ursing a positive view of to practice; are working with older well mentored on adults. placement; wit- •V ness quality care

ol in well-resourced environments; and . xx feel valued when

, N on placement. o Robinson et al. Australia Investigated Action research Meetings, surveys, 60 (2nd year) Comprehensive Students not asked . xx (2008) clinical placements checklists orientation prac- for reasons

, 20 with enhanced ori- tices necessary entation practices. for students and xx clinical staff; 35% improvement in attitudes to work in aged care. Abbey et al. (2006) Australia Explored the Qualitative Nominal groups, 14 (2nd year) Clinical place- Paired with lesser impact of clini- semi-structured ments seen as an qualified health cal placement interviews. opportunity to workers for clinical on perception of practice “basic” placement; basic gerontological skills only; stu- care, not acute; no nursing and effect dents felt poorly career pathway; on career prefer- prepared for the low pay ences. placement; did not value the role of the RN; and saw it as an end point in career. Williams, Nowak, & United States Evaluated the im- Qualitative Focus groups 32 (final year) Students valued Students not asked Scobee (2006) pact of placement the clinical place- for reasons in a long-term care ment but did not facility. see long-term care as a career path. 5 rontological nurses as instructors ing rates poorly as a career path and tation. Students were issued orienta- were also noted as deterrents. A this is driven by this area of nursing tion packets upon arrival, staggered comprehensive review of geronto- being perceived by students as unin- shift starts to improve preceptor/ logical curricula was recommended. spiring and fraught with poor work- student engagement, and informa- Similarly, Kloster et al. (2007) found ing conditions. How to comprehen- tion regarding placement objectives gerontology was the least preferred sively address these issues remains and expectations. These measures re- specialty and recommended that tim- the challenge for the discipline. sulted in a positive improvement in ing of clinical placements was crucial students’ attitudes toward employ- to ensure that students appreciated Innovative Curriculum Activities ment in aged care from 55% to 90%. the complex nature of gerontological The following studies used in- These four studies represent at- nursing; they also noted addressing novative curriculum activities to tempts to use innovative curriculum negative societal and media coverage improve the uptake of gerontologi- activities with the aim to change the may improve recruitment. cal nursing as a graduate specialty, negative perceptions undergradu- DeKeyser Ganz and Kahana albeit with little success. However, ate nursing students have toward (2006) studied the impact of culture through the review process, a num- a career in gerontological nursing. by examining social need, social ber of sound recommendations to The activities centered on greater prestige, interest in clinical areas, address this issue have come forward. preparation of students in regard and career preference. Poor percep- In analyzing the experiences of both to nursing older adults and prepar- tions of gerontological nursing did students and clinical teachers gained ing qualified clinical staff to provide not change over time, with posi- from a LTC clinical placement, Ab- an enhanced clinical experience for tive exposure to clinical areas and bey et al. (2006) identified that prep- students. Studies were conducted in clinical nursing faculty eliciting only aration for the clinical placement for acute and LTC facilities. Although minor influences on career prefer- staff, students, and clinical teachers some positive changes were noted ences. The perception of “nurses was the key for creating a successful with enhanced clinical exposure to save lives” as opposed to chronic placement. Exposure to gerontologi- older adults, a career in gerontologi- and long-term care had a significant cal curriculum prior to placement, cal nursing was viewed more as an impact on career preferences. Rejeh, ensuring clinical teachers were ex- endpoint rather than a starting point. Heravi-Karimooi, and Vaismoradi perts in gerontology, and enabling (2011) conducted their study in two RNs time to mentor students were DISCUSSION teaching hospitals in Tehran, Iran, as also considered vital. Williams et This literature review, spanning older adults are generally cared for al. (2006) designed a project where seven countries, demonstrates that at home, and consequently, LTC fa- placement objectives focused on the a career in gerontological nursing cilities do not exist. Students found RN role, which included the appli- is not rated high for undergraduate that working with this population in cation of gerontological theory and students and nothing has changed in the acute setting was challenging and patient data management. Students 10 years. Specific reasons students frustrating. On a more positive note, were able to identify the key features identified for why they do not want religious and cultural expectations of the nursing role such as excellent to work with older adults are out- encouraged students to persevere communication skills, advanced del- lined in Table 2. Although there are with the working conditions, and egation and supervising skills, and many issues that affect the decision positive experiences and witnessing the ability of the nurse to precipitate about where to work after gradua- competent nurses improved their patient and environmental change. tion, four key issues were identified outlook. However, despite the positive experi- through this literature review: (a) Taken together, these eight stud- ences conveyed, none of the students societal values about aging; (b) un- ies determined the career preferences expressed a desire to work in LTC dergraduate nursing curriculum; (c) of undergraduate nursing students following graduation. Similar results clinical placements; and (d) working and the reasons for not choosing were found by Brown, Nolan, Da- conditions that may provide the im- gerontology (Table 2). Four of the vies, Nolan, and Keady (2008) who petus for deliberation and action. studies were undertaken in Australia created “enriched environments” to with other studies from Israel, Iran, support a sense of security for the Societal Values About Aging China, and Norway. A variety of student in acute and long-term care. Fundamental to the issue as to study methods were used with dif- Robinson et al. (2008) had more why undergraduate nursing students ferent sample sizes of students across success with the introduction of a are not viewing gerontological nurs- all stages of their nursing studies. comprehensive orientation program. ing as a viable career preference lies in Despite these differences, the results Preceptors from the LTC facilities current societal values about nursing were similar. Gerontological nurs- were responsible for student orien- and aging and how this is reflected in

6 Copyright © SLACK Incorporated key carriers of information such as Association of Colleges of Nurs- strengthen curriculum delivery of the media. Brown, Nolan, and Davies ing, called the Geriatric Nursing gerontological nursing could focus (2008) argued that the problem lies in Education Consortium (GNEC), to on faculty characteristics that influ- that nursing is now focused on “cur- enhance geriatric content in senior- ence student career preferences upon ing” rather than “caring.” Caring is level undergraduate courses (Wilson, graduation and how these findings seen as a personal attitude or psy- 2010). The GNEC provides faculty could be applied to gerontological chosocial skill that should be found with extensive state-of-the-science nursing. Additionally, research could in everyday life and not inherent in resources developed by experts to look at how faculty champions for a nurse’s role. Historical imagery of champion geriatric education, train gerontological nursing could be cre- compassionate, “caring” nurses at other faculty, and oversee the revi- ated and the effect of such positions the bedside during humanitarian or sion of curricula. Evaluations have on students’ career preferences. military deployment are long gone, revealed that the resources are being replaced by highly trained, profes- widely used for curriculum develop- Clinical Placements sional nurses working in acute care ment and teaching (Wilson, 2010). The impact of clinical place- settings. Students’ career preferences Internationally relevant programs ments to create lasting impressions for pediatrics, midwifery, and critical such as this and others by the Hart- for undergraduate students is often care simply reflect society’s high val- ford Geriatric Nursing Initiative, underestimated by educators, clini- ue placed on youth, cure, and tech- which involve nurses from around cians, administrators, and future em- nological advances in health care. the world, have ensured that under- ployers (Abbey et al., 2006; Brown, Furthermore, Bosco et al. (2005) and graduate nursing students are likely Nolan, Davies, Nolan, et al., 2008; McCann et al. (2010) suggested that to graduate with competencies in ge- Chen, Brown, Groves, & Spezia, this view is perpetuated by the me- rontological nursing (Bednash, Me- 2007; McCann et al., 2010; Neville, dia by portraying these specialties zey, & Tagliareni, 2011). Yuginovich, & Boyes, 2008; Stevens, as glamorous and technologically The poor recruitment of expert 2011). One recurring issue is about advanced. Limited exposure is given gerontological nurses into faculty the timing of the clinical placement to gerontological nursing and if aged is a concern (Abbey et al., 2006). and its effect on nursing students’ ca- care issues are presented in the me- Although DeKeyser Ganz and Ka- reer preference (Kloster et al., 2007; dia, older adults are rarely portrayed hana’s (2006) Israeli students found Williams et al., 2006). Traditionally, as independent, healthy individuals that the presence of gerontological in many nursing programs, first-year with the ability to contribute to the faculty did not have a significant nursing students are exposed to ge- wider community. This reinforced effect on career preferences, other rontological nursing during their negative societal view affects stu- researchers from Australia and Iran first clinical placement, usually in dents’ perceptions of older adults suggested that if this component of a LTC facility (Abbey et al., 2006). prior to commencing undergradu- the curriculum is left to other aca- Clinical placements during this time ate nursing studies and consequently demics, they often miss the salient primarily focus on the consolidation where they may want to work when points of nursing older adults (Mc- of psychomotor skills (e.g., bathing, they graduate. To overcome these Cann et al., 2010; Rejeh et al., 2011). feeding) (Chen et al., 2007), with stu- problems, educators in nursing may Some progress to address these gaps dents often paired with lesser quali- be able to develop and evaluate en- has been made, for example, the fied health workers (Abbey et al., gaging teaching strategies to assist Faculty Learning About Geriat- 2006; Kloster et al., 2007). Although students in gaining the skills to cri- rics (FLAG) program developed in this partnership can allow students tique the portrayal of aging by the the United States aimed to enhance to communicate with older adults media. faculty interest and knowledge re- and members of the health care team, garding gerontological nursing professional mentorship may be lim- Undergraduate Nursing Curriculum (Edelstein, Cheung, Voss, & Kaas, ited. As Abbey et al. (2006) found, Over the past decade, undergrad- 2011). FLAG participants attended students were not exposed to the role uate nursing curriculum developers a 1-week intensive gerontological of the RN; therefore, further disen- have acknowledged gaps regarding course, had a year-long mentorship gagement in gerontological nursing the delivery of gerontological the- program, and ongoing opportuni- occurred. ory. Students cannot be expected to ties for continuing education, with Introducing gerontology place- choose a particular career path if they outcomes such as improved teaching ments in the final year of nursing lack confidence in their knowledge efficacy, use of new curricular strate- programs appeared to improve nurs- and skills (Rejeh et al., 2011; Shen & gies, and expressed interest in geron- ing students’ interest in a geronto- Xiao, 2012). A major initiative has tological nursing by students (Edel- logical nursing career (Kloster et been undertaken by the American stein et al., 2011). Future research to al., 2007). Moreover, Robinson et al.

Journal of Gerontological Nursing • Vol. xx, No. xx, 20xx 7 (2008) found that a comprehensive clinics, and LTC facilities to health equately prepare and organize staff orientation of both the student and promotion clinics, which is not of- and students prior to clinical place- staff at the LTC facility improved ten recognized. Career preferences ments. Comprehensive orientation the outlook of the student toward were analyzed; however, conversion programs will ensure that both stu- gerontological nursing. A supportive to employment rates in gerontologi- dents and staff feel supported during orientation program increased the cal nursing were not identified. This this time. Students need to be along- students’ feelings of being welcomed is an important component of work- side RNs rather than lesser qualified and valued while on placement, and force planning that warrants atten- health workers to enable students to the involvement of the staff increased tion. Comparison of studies for this witness the gerontological nurse un- their interest in mentoring the stu- review was not easy because methods dertake his or her role. The introduc- dents. These recommendations can varied from qualitative interviews tion of graduate gerontological nurse be applied to any clinical placement and focus groups to quantitative programs may improve preceptor- in gerontology, not just LTC. Clem- cross-sectional and longitudinal de- ship of novice nurses; however, such mens et al. (2009) created an interdis- signs. Additionally, generalizing to programs and any other initiatives ciplinary community health learning a wider population is difficult when need to be evaluated to determine experience with significant outcomes studies have small samples (five stud- whether there is any influence on of increased knowledge, skill, and ies N = 32 or less). the career preferences of nursing stu- interest in community care of older dents. adults to the extent that graduates IMPLICATIONS FOR NURSING were employed in the sector. Future As a profession, there is much we CONCLUSION research could explore the use of a need to do to improve this signifi- From the literature, it has been variety of instructional strategies for cant part of our practice. Negative identified that modifying societal implementing the clinical placement societal views of older individuals attitudes, evaluating undergradu- designed by a team that includes fac- are perpetuated in the media and ate nursing curricula together with ulty, students, preceptors, clinicians, this needs to be addressed. Geron- a comprehensive clinical placement administrators, and consumers. tological nurses need to assist their review, and addressing working con- profession by dismissing the mis- ditions are essential in promoting Working Conditions Within the guided perception that the specialist gerontological nursing as a desirable Health Sector role is simply hard physical labor. career preference for undergraduate Finally, the aged care and acute The reality is that most gerontologi- students. Nursing curricula need to health sectors must assume account- cal nurses working in LTC are paid be delivered by expert gerontologi- ability for their role in the develop- less than those in primary and acute cal nurses to inspire undergraduate ment, mentorship, and recruitment care sectors, despite their complex nursing students to care for older of RNs and to improve working role. It must be acknowledged that adults. Clinical placement options conditions. If students are exposed gerontological nurses do not solely should include healthy aging clinics to working conditions such as high work in LTC, and a large proportion and areas of older adult health pro- workloads, poor remuneration, lim- of people admitted to acute care are motion, and should not be restricted ited access to educational opportuni- older than 65. It is the nurses’ role to to basic nursing care within LTC fa- ties, and inadequate skill mixes, there promote their specialty as a positive cilities. Clinical placements should will undoubtedly be problems with career choice and they need to be the be considered over the duration of recruitment and retention (Abbey et champions of this change. Within the undergraduate nursing course, al., 2006; Reinhard, Barber, Mezey, this role, advocating the importance and not limited to first-year studies, Mitty, & Peed, 2002). Addressing of the gerontological specialty to as this diminishes the complex role these issues and researching the same professional bodies, government, of the gerontological nurse. Good will provide quality clinical place- and universities is vital in further ad- working conditions are required to ments, expose students to the expert vancing the cause. attract qualified staff. gerontological RN role, and develop University faculty need to enlist close associations with the univer- the expertise of gerontological nurses REFERENCES sity sector. 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(2008). Transforming students’ three-year longitudinal study. Nurse Edu- ing. Retrieved from http://www.who.int/ views of gerontological nursing: Realising cation Today, 30, 31-36. doi:10.1016/j. ageing/about/facts/en/index.html the potential of ‘enriched’ environments nedt.2009.05.014 of learning and care: A multi-method, lon- The Mid Staffordshire NHS Foundation ABOUT THE AUTHORS gitudinal study. International Journal of Trust. (2013). Report of the Mid Stafford- Dr. Neville is Associate Profes- Nursing Studies, 45, 1214-1232. shire NHS Foundation Trust public in- sor, Deputy Director, Ipswich Clinical Centers for Disease Control and Prevention. quiry executive summary. Retrieved from School, The University of Queensland, (2011). Older persons’ health. Retrieved http://www.midstaffspublicinquiry.com/ School of Nursing and Midwifery, from http://www.cdc.gov/nchs/fastats/ sites/default/files/report/Executive%20 and Ms. Dickie and Ms. Goetz are older_americans.htm summary.pdf Clinical Lecturers, The University of Chen, S.L., Brown, J.W., Groves, M.L., & Neville, C.C., Yuginovich, T., & Boyes, J. Queensland, School of Nursing and Spezia, A.M. (2007). Baccalaureate educa- (2008). A stock-take of existing aged care Midwifery, Ipswich, Queensland, Aus- tion and American nursing homes: A sur- clinical placements for undergraduate tralia. vey of nursing schools. Nurse Education nursing students in Australia. Australian The authors have disclosed no po- Today, 27, 909-914. Journal of Advanced Nursing, 26(2), 17-26. tential conflicts of interest, financial or Clemmens, D., Goldstein, J.M., Clarke, K., Reinhard, S.C., Barber, P.M., Mezey, M., Mitty, otherwise. Moriarty, M., Soberman, R.K., & Gardner, E.L., & Peed, J.A. (2002). Initiatives to pro- Address correspondence to D.S. (2009). Geriatric nursing education in mote the nursing workforce in geriatrics: A Christine Neville, PhD, RN, FACMHN, community health: CareLink—partnering collaborative report. Retrieved from http:// Associate Professor, Deputy Director, for excellence. Journal of Gerontological www.cshp.rutgers.edu/Downloads/1600. Ipswich Clinical School, The University Nursing, 35(4), 44-50. pdf of Queensland, School of Nursing and DeKeyser Ganz, F., & Kahana, S. (2006). Per- Rejeh, N., Heravi-Karimooi, M., & Vaismo- Midwifery, 11 Salisbury Road, Ipswich, ceptions of Israeli student nurses regard- radi, M. (2011). Iranian nursing students’ Queensland, Australia 4305; e-mail: ing clinical specialties and factors that perspectives regarding caring for elderly [email protected]. influence these perceptions. Journal of Ad- patients. Nursing & Health Sciences, 13, Received: February 15, 2013 vanced Nursing, 56, 88-98. 118-125. Accepted: October 3, 2013 Edelstein, J.A., Cheung, C.K., Voss, J.A., & Robinson, A., Andrews-Hall, S., Cubit, K., Posted: December 4, 2013 Kaas, M.J. (2011). The Faculty Learn- Fassett, M., Venter, L., Menzies, B., & doi:10.3928/00989134-20131126-02 ing About Geriatrics (FLAG) program: Jongeling, L. (2008). Attracting students Bringing together experts in geriatric to aged care: The impact of a supportive nursing education. Journal of Continu- orientation. Nurse Education Today, 28, ing Education in Nursing, 42, 378-384. 354-362. doi:10.3928/00220124-20110516-02 Royal College of Physicians. (2013). Putting Eldercare Workforce Alliance. (n.d.). Geriat- patients first: Realising Francis’ vision. rics workforce shortage: A looming crisis Retrieved from http://www.rcplondon. for our families. Retrieved from http:// ac.uk/sites/default/files/francis-inquiry- www.eldercareworkforce.org/files/Issue_ response-exec-summary.pdf Brief_PDFs/EWA_Issue.Supplydemand. Shen, J., & Xiao, L.D. (2012). Factors affect- final-3.pdf ing nursing students’ intention to work Gilje, F., Lacey, L., & Moore, C. (2007). Ger- with older people in China. Nurse Edu- ontology and geriatric issues and trends in cation Today, 32, 219-223. doi:10.1016/j. U.S. nursing programs: A national survey. nedt.2011.03.016

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