"I started working at UHN three years ago," says Patrice Wedderburn, a clinical nurse specialist in Geriatric Emergency Medicine at Toronto Western Hospital. "I was drawn to UHN for their emphasis on support and on teamwork. Care for older adults in the ED is a team effort. I am fortunate to have a great team." (Photo: UHN Foundation)

Patrice Wedderburn is a clinical nurse specialist (CNS) in Geriatric Emergency Management (GEM) at Toronto Western Hospital, a role she describes as "the best of both worlds" in that it combines acute and primary care.

In her role, Patrice cares for older adults, who represent approximately 30 per cent of visits to the Emergency Department (ED), the highest visit rate of any segment of the population.

On Tuesday, Oct. 25 from 5 p.m. to 6 p.m., Patrice will talk about her role in a live virtual panel discussion – "Let's Talk: A Practical View of Nursing in an Aging Population." The event, part of the UHN Nursing Speaker Series, is hosted by UHN Chief Nurse Executive Pam Hubley.

In anticipation of the event, Patrice talked with UHN News about her career path and caring for older adults.

Q: What can you tell us about the senior population and ED visits?

At any given time, there is a high demand for care for older adults in the ED. The GEM CNS role was created in 1994 as a way to increase access to care for seniors, identify and address geriatric syndromes (such as falls, impaired mobility, dementia, and depression) that place them at an increased risk for occurrence of loss of independence and adverse health outcomes.

Q: What is GEM at UHN?

At UHN, GEM can mean two things. It could refer to the Geriatric Emergency Medicine Team – a growing initiative at UHN – and includes GEM CNSs, or it could refer specifically to the geriatric emergency management Clinical Nurse Specialist role.

A GEM CNS at UHN is a Master's degree-prepared registered nurse with additional training and specialization in gerontology. The GEM works collaboratively with patients and their caregivers, inpatient teams, Allied Health, community organizations and healthcare providers to maximize a patient's functional status, independence, and improve the quality of life. GEMs also work to build capacity and facilitate smooth transitions back the community to assist patients to age place when possible.

The GEM role at TWH was started by my mentor, Petal Samuel. There are three GEM CNSs at UHN and more than 120 GEMs in EDs across Ontario.

Q: When did you know this area of nursing was the right fit for you?

I started my career as a registered nurse in acute care. It was stressful at the bedside; patients were very sick with high care needs. What was most distressing was that they kept coming back to the unit, sometimes more unwell than when they left. I wondered why this was happening, and I wanted to work on prevention and take a more comprehensive approach to care.

I started working in primary care to understand how I could help, and that's when things changed for me. I noticed a trend; I would see older patients discharged from the ED who didn't know their plan of care. I found myself calling the ED and trying to navigate the hospital system from the outside, and that proved very challenging.

At that time, I wanted to apply to a Master's program to take the next step in my career, but I needed a strong reason. The patient experiences I encountered gave me the reason, and geriatrics found me. As I was completing my Master's, I narrowed my focus to geriatrics. The opportunity of working as a GEM nurse then came to my attention. It was truly the best of both worlds (acute care and primary care). It was the niche I was looking for. 

Q: What is your role with GEM at Toronto Western Hospital?

I started working at UHN three years ago. I was drawn to UHN for their emphasis on support and on team work. Care for older adults in the ED is a team effort. I am fortunate to have a great team.

My role is supported by the Regional Geriatric Program (RGP) and involves working with the ED team to complete targeted/comprehensive geriatric assessments, discharge planning, care coordination, advocacy, staff education, and quality improvement initiatives within the ED.

As a GEM, sometimes I wear different hats to facilitate care for patients. Part of my role is to identify gaps and fill them. Is this person safe for discharge? If not, what can be done, how can we make it safe? What supports are available in the community? I need to feel that the patient is safe to go home. I need to feel that we have done our best, we have done what we can given the resources we have.

Q: Tell us about the new role you're about to take on?

I will commence a year-long secondment at Toronto Rehab as an Advanced Practice Nurse Educator to help with orientation and education of new staff, and help improve practice. This position will allow me to have a panoramic view of care for older adults and an opportunity develop additional advance practice skills much needed in my current practice.

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