They don't make nurses like they used to. Gone are the days when they played 76th trombone to the physician's first.
They don't make elderly people like they used to, either. In many areas of the District, they have stopped calling their doctors whenever they have a slight pain. Instead, they let a student from George Washington University's Adult/Geriatric Nurse Practitioner Program handle the problem.
"Attitudinally, the elderly are separated from the society," said program director Jean Johnson. "We're trying to integrate them more. At the same time, we're giving our students a chance to practice primary health care, become more independent and, hopefully, increase their earning power," said Johnson. "And we're performing a valuable community service."
The program, one of nine in the country prepariang graduates for certification as geriatric nurse practitioners, will graduate its first class of 15 on Saturday. They must later pass an exam given by the American Nurses Association.
Nurse practitioners are registered nurses whose additional education qualifies them to take histories and perform physical examinations on patients. They also manage patients with chronic disease and minor illnesses. Nurses can generally earn more money as nurse practitioners.
Part of GWU's School of Medicine and Health Sciences, the geriatric program began as a family nurse practitioner course and evolved into its present from last August.
"The university has a strong commitment to geriatrics," Johnson explained. "Geriatrics in long-term care institutions are badly underserved, and we saw this course as a way to fill that need."
"We tried to define populations in the District whose medical needs weren't being met," says clerical coordinator Diane Guida, "and the elderly were all but screaming, 'Take me, take me.'"
So the university did. Johnson, who has a master's degree in nursing and certification as a geriatric nurse practitioner, joined the faculty at the School of Medicine and Health Sciences to develop a curriculum.
To be admitted to the 12-months of courses, students must be licensed nursing school graduates and must have at least two years' practical experience.
In addition to classroom instruction, students also take a 12-week clinical seminar including adult primary care, geriatric health care and ambulatory gynecology.
For two semesters, each student also is assigned to, and visits weekly, an elderly resident of St. Mary's Court, a congregate housing unit adjacent to the medical school.
"This gets you out of the hospital environment and closer to the patients," said student Cheryl Myers, who spent 12 years at the Washington Hospital Center. "This is perfect for me because I was tried of working in a hospital. I wanted a new role, and this was the most complete program to do it . . .
"You move up the career ladder, but not away from the people. You really learn to respect the elderly and find out how fascinating they are. It's going to help me age better, both by myself and with my parents."
Encouraging geriatric education has been difficult, Johnson said, partly because the country's long-term care network -- nursing homes and similar facilities -- offered little to attract nurses. Sen. Daniel Inouye (D-Hawaii) has introduced a bill that would reimburse nurses in long-term care facilities on a per-patient basis, she said, much as doctors are reimbursed now under some programs.
"I think courses like this are changing things," said Johnson. Some problems attributed to "old age" can be minimized, and doctors don't seem that interested in solving them, she said. "But practitioners are, and they're capable of solving them. When these students leave here, they'll have a lot more control over their futures."