Nurses Improving Care for Healthsystems Elders (NICHE)

Nurses Improving Care for Healthsystems Elders (NICHE)

Background & Goals

The major healthcare challenge addressed by Nurses Improve Care for Healthsystems Elders (NICHE) has been the need for evidence-based knowledge in the nursing care of older adults. Older adults are the largest consumers of hospital care, accounting for 17% of all hospital admissions.

NICHE has successfully developed this knowledge by pioneering the development of geriatric nursing clinical protocols, and most importantly, has developed a sustainable model for knowledge transfer across multiple healthcare delivery systems with nursing staff at all levels of practice encompassing CNAs, LPNs, RNs, APRNs.

NICHE transforms the organizational environment by adjusting staffing patterns and the physical environment to reduce preventable institutionally-acquired complications of delirium, falls, skin injuries, and functional decline among older adults. These iatrogenic complications are costly; reducing them is the focus of national quality initiatives.

NICHE pioneered the development of evidence-based practice by nurses at the bedside. In the 1990s, NICHE leaders marshaled the evidence of the emerging field of geriatric nursing and packaged this knowledge in an accessible format for use by clinical nurses.

Program Description

NICHE focuses on the care of adults, aged 65 and older, by improving systems of nursing care for this population. NICHE is an evidence-based, organizational intervention led by nurses to deliver high-quality, safe, and reliable geriatric care during hospitalization and skilled nursing admissions.

NICHE closes the documented gaps in the knowledge and competencies of the nursing workforce to meet the health needs the population of older adults (numbering 54 million in the US), by offering continuing education for nurses employed in hospital and skilled nursing facilities (SNFs) to develop expertise in geriatrics. NICHE advances nurses’ position and contributions within interdisciplinary care teams that are required to deliver effective geriatric care. The Geriatric Resource Nurse (GRN) and Geriatric Nursing Assistant (GNA) roles are the hallmark of the NICHE model. These unit-based leadership roles support a culture of care focused on identifying and managing geriatric syndromes during periods of acute illness, rehabilitation, and long-term care.

The NICHE model integrates four mutually reinforcing elements:

  • The Geriatric Resource Nurse (GRN) role to advance clinical specialization in geriatrics, unit leadership, and evidence-based practice. GRNs are peer mentors, coaches, and agents of change on their units who work to create an environment that promotes optimal care of older adults.
  • Nurse-initiated protocols to manage the geriatric syndromes, iatrogenic events, and harmful sequelae of hospitalization.
  • A physical environment and culture of care that honors older adults’ self-determination and promotes quality, safety, and function.
  • Nurse-led care transitions that emphasize interprofessional care planning; preparation for patients and family caregivers; and complex symptom management.

Evidence of Success

In the past three years, more than 40,000 nurses working in 400+ NICHE member hospitals and SNFs have completed continuing education to prepare them for the GRN role. In 2020, NICHE offered more than 100 hours of continuing education programming to 57,951 participants who completed the Leadership Training Program, the GRN and GCNA courses, or webinar series.

NICHE has been adopted by nearly 10% of US hospitals, which in turn care for an estimated 1.5 million older adults annually. NICHE is designed to meet consumer, payor, and societal expectations for quality, value and improvements in health and quality of life.

The 2019 review of forty-three empirical studies by Squires et al. concludes that the NICHE practice model is significantly associated with improvements in clinical outcomes aligned with national quality measures including fall prevention and reduction; appropriate medication prescribing; dementia symptom management; delirium care; reduced catheter acquired urinary infections (CAUTIs); and expansion of advanced care planning services.

For More Information Contact:

Mattia J. Gilmartin, PhD, RN, FAAN