Using nurse practitioners to implement best practice care for the elderly during hospitalization: the NICHE journey at the University of Virginia Medical Center.

The Nurses Improving Care to Health System (NICHE) program has provided a valuable framework for developing initiatives that address the needs of the elderly. Three NICHE models have been implemented within the University of Virginia Health System since 1992. These include the Geriatric Resource Nurse model, the Acute Care of the Elderly model, and, most recently, the Geriatric Consultation Service model. Nurse practitioners (NPs) with geriatric expertise have provided the leadership in implementing these initiatives to achieve the goal of improving geriatric care delivery within the health system. Each NP functions in a broad role that is tailored to meet the needs of the patients and staff and includes the role components of clinician, educator, team leader, and care coordinator. Sustainability and growth of NICHE is contingent upon demonstrating favorable outcomes that can be directly attributed to NICHE.