Nurses in staff development are responsible for assuring nurses' competence in the delivery of care. Older patients are the predominant population in hospitals, yet there are no instruments that specifically assess the competency of nurses to deliver care to older patients. This article reports on the development and testing of an instrument, Geriatric Competencies for RNs in Hospitals, and makes recommendations as to how staff development educators can use the geriatric competency instrument with staff nurses.

Objective This study examined heel ultrasonography, levels of 25-OHD, and levels of urinary NTX-I in patients with a recent osteoporotic hip fracture to see if they were clinically useful. Methods T scores of stiffness index(SI) obtained from quantitative heel ultrasound(QUS), levels of serum 25-hydroxyvitamin D(25-OHD) and levels of urine N-terminal cross linking telopeptide of type I collagen(NTX-I) were obtained in 53 female and 32 male hip fracture patients. Sixty five female patients and five male patients attending our geriatric clinic were used for comparison. Results The T scores of SI of the hip fracture patients were less than those of the geriatric clinic patients. The difference was signficant in females(p = 0.0001), but not in males (p = 0.1). Serum levels of 25-OHD were less than 28 ng/ml in 50 out of 59 patients, and less than 5 ng/ml in two patients. Levels of urinary NTX-I were variable, and were not correlated with other parameters. Conclusions Patients who have sustained a hip fracture have a low SI determined by QUS; this is easy to perform and it provides a baseline T score from which to assess treatment effects. The majority of these patients are vitamin D deficient and measurement of the level of 25-OHD would enable physicians to prescribe an appropriate dose of vitamin D. Urine NTX-I measured shortly after a hip fracture is not clinically helpful.