Grand River Hospital has five medicine units, a total of 96 beds, dedicated to the care of adult patients. Currently frail older adults are admitted and dispersed throughout the medical beds.

In recognition of the complex needs of these older adults, Grand River Hospital (GRH) has initiated the establishment of an Acute Care for the Elderly (ACE) unit. During planning for this unit a possible gap in service was identified with relation to geriatric care when research demonstrated that few nurses have specialized training in geriatric care (Berman et al., 2005 and Gilje, Lacey, & Moore, 2007). This lack of knowledge of the ageing process could result in nurses being unable to modify care, potentially placing elderly patients at risk for adverse events. Mindful of these issues, my RNAO fellowship focused on identifying nursing knowledge gaps related to geriatric care and developing educational programs to meet these needs. Implementation and evaluation of at least one of the new modules was also planned. The complexity of creating an educational intervention that considered the needs of adult learners, and in particular medicine nurses, as well as the specific needs of GRH quickly became apparent.

To begin my fellowship, I needed to develop an understanding of the importance of establishing an ACE unit. This step started with an exploration of the literature regarding the benefits and roles of an ACE unit. I learned that for the elderly, the ACE model of care is recognized as a best-practice model and through specialized geriatric care can improve patient outcomes. My literature review allowed me to compile a list of evidence-based references and resources that contain a wealth of knowledge. This list also provides a foundation for my future learning as development of the ACE unit proceeds.

Recognizing the importance of developing effective educational programs, I enrolled in an online course to improve my knowledge about the principles of adult learning. This phase of my fellowship helped me to explore many different theories and models for education, but there was minimal literature encountered that specifically related to adult nurses caring for geriatric patients. However, I did identify general key principles for adult educational programs including: the use of a didactic approach in combination with case studies and interactive learning. The importance of an assessment of learning needs and an evaluative component were also acknowledged.

I conducted a second literature review to allow me to focus my learning needs assessment on possible existing nursing knowledge gaps. As my fellowship journey continued evidence from my literature reviews was combined with information gathered from linking with clinical experts in already established ACE units at Mount Sinai Hospital, Toronto and London Health Sciences. My site visits provided valuable learning experiences. The ability to view functioning ACE units and to dialogue with experts in the field has contributed to my knowledge of geriatric care and nursing education. Each professional that I encountered was able to offer support and information related to their style of teaching, relevant learning needs, and strategies to face the challenges inherent in nursing education. I believe that the contacts and relationships I developed during this fellowship will continue throughout my career. Through these interactions, I was able to identify approaches and topics for incorporation into my educational program, as well as new ways to manage routine clinical issues. My site visits and interviews also helped me to explore the roles of the Education Practice Lead, Nurse Practitioner, and Clinical Nurse Specialist in relation to geriatric care. Though not a goal of my fellowship, I now have a better understanding of these nursing roles and how they can be incorporated into an ACE unit.

The experience of the RNAO Advanced Practice Clinical Fellowship has been unlike any other I have had in my career. This unique opportunity has enabled me to become actively involved within the organization, in a different role. By setting learning goals and targets, I was able to accomplish more than I imagined for myself, my fellow nurses, and for the organization as a whole. By achieving learning goals like research skills, presentation skills, and knowledge and skills in elder care (specifically falls and continence promotion), I have improved my confidence as a nurse. This fellowship has also strengthened my knowledge of organizational processes, educational skills, change management abilities, and leadership qualities. I have made connections with interdisciplinary colleagues internal and external to the organization and have vastly expanded my professional network. Although this particular phase has been time limited, the journey for me as an educator continues as I plan to present at Nursing Rounds and at geriatric educational sessions being hosted by my primary mentor. I strongly believe that the knowledge and experience I have obtained in my RNAO fellowship will be instrumental in guiding the development of future educational experiences for nurses working on the ACE unit.

Key deliverables for my organization are the creation of pamphlets describing the ACE unit for staff and patients/families, the development of a Falls Prevention and Management educational seminar, the design of an online learning module for Continence promotion, the identification of a survey that can reliably be used to evaluate and re-evaluate nursing knowledge regarding geriatric care, and a compilation of evidence-based resources supporting the development of an ACE unit. Throughout my fellowship I shared my knowledge with colleagues through many informal discussions, educational sessions, and through creation of my final research report. My site visits have also contributed to the organization as I have a list of admission criteria, geriatric educational resources, and clinical management strategies that can be used on ACE units.

I am a much more knowledgeable, confident and motivated nurse because of the RNAO Advanced Practice Clinical Fellowship and my career path has changed for the better because of it. I would like to extend my appreciation to my mentors with whom discussions helped to expand, support, and guide my thought processes and learning experience. My mentors provided a wealth of knowledge and experience in geriatric care. They have helped me to understand the history and future aspects of geriatric care at GRH. Lastly, I would like to thank RNAO, my manager, my director, and GRH for this wonderful learning opportunity.

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