Phyllis Atkinson, GNP
"I realized that I wanted to know how older people differ from younger people and that I wanted to be an advocate for them."
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 heath 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.
Fresh out of graduate school, Atkinson got just the job she was looking for. She was hired to help create and to coordinate a geriatric assessment center at Cincinnati's Bethesda Hospital. The center provided comprehensive evaluations of older adults living in the community.
"It was extremely gratifying," recalls Atkinson. "Our first patient was an elderly gentleman who started to experience cognitive and functional decline and required a lot of assistance. We discovered that he had a pretty significant vitamin B 12 deficiency that had been overlooked before. When we treated it, his cognition improved, as did his functional status."
While working at the assessment center, Atkinson also helped establish a Program of All-Inclusive Care for the Elderly (PACE) affiliated through Bethesda Hospital. PACE programs, funded jointly by Medicare and Medicaid, provide comprehensive medical, social, and other services that help older adults stay in the community and avoid institutionalization. When Atkinson and her husband became primary caregivers for his aged grandmother not long after the program debuted, PACE provided services that helped ease the heavy burden of caring for her during her last years, Atkinson recalls.
Atkinson ran the Bethesda Hospital assessment center for nearly five years. She left in 1998 after a physician certified in geriatrics contacted her and asked her if she'd help him start a practice providing primary care to nursing home residents in northern Kentucky. When they started the practice, in 1998, they saw patients in just one nursing home. Within three years, they were providing care to residents of 11 homes. It was while she was involved with the practice that Atkinson also started teaching at Northern Kentucky University. She teaches both students in the university's GNP program and its adult nurse practitioner and family nurse practitioner programs.
"There aren't a lot of NPs in the geriatrics program, or a lot of GNPs, period; so a lot of the students in the adult and family nurse practitioner programs are going to end up taking care of a lot of older adults," says Atkinson. "I want them to know as much about caring for older people as possible."
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.
In 2001, Atkinson left the practice in Kentucky for a foray into research, joining a Dayton, Ohio Veteran's Administration study evaluating interventions designed to keep older adults in the community. She was involved in the branch of the study examining whether nurse practitioners making house calls to community-living older adults could help these adults stay out of institutions. Data from the study were very promising. As it turned out, though, the job required that she spend far more time inputting data than working with patients -- which was what she most wanted to do. After a year, she accepted her current job with Evercare, a nationwide company that provides nurse practitioners to long-term care facilities. Initially, she saw patients herself, but a year ago she was promoted to her current managerial position. The 10 nurse practitioners she oversees have caseloads of 80 to 100 patients each and Atkinson, who relishes patient care, enjoys helping out by seeing patients herself now and then. She also enjoys the teaching that the job entails. Few of the nurse practitioners she oversees are GNPs, so Atkinson wears her teaching hat at both her Evercare office and Northern Kentucky University.
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."
