Specialized nursing shows Niagara Health’s commitment to older adults




Julie Rubel understands the appeal of being an emergency department nurse.

She gets the thrill of working in maternity and welcoming new lives to the world.

But Rubel, a clinical nurse specialist in geriatrics at the Niagara Falls Hospital, is among a unique group of healthcare professionals to know the pure joy that comes from working with older adults who have a variety of care needs.

“It’s being able to connect with people with rich life histories and life experience, and wisdom to share, which is often,” Rubel says. “For most people, it’s not every day you get to meet someone who’s had a life of experience.”

Rubel is the first clinical nurse specialist in geriatrics at Niagara Health and one of only six clinical nurse specialists within the organization.

She was promoted to the position in 2022 after completing her master’s degree in nursing and qualifying as an advanced practice nurse, an umbrella term for clinical nurse specialists and nurse practitioners. Unlike nurse practitioners, Rubel can’t diagnose and prescribe, but she does use her additional credentials to consult and do clinical work with older adults who have more complicated health challenges, including those experiencing inequities in the key social determinants of health or who demonstrate challenging behaviours related to dementia.

She supports other teams that are part of Niagara Health’s Care for Older Adults Strategy, including the Geriatric Assessment Program (GAP), where Rubel previously worked as a registered nurse, and Behavioural Supports Ontario.

Nursing for the bigger picture

Coaching is also part of Rubel’s portfolio. She teaches evidence-based skills to help staff and students work with older adults with dementia or cognitive impairments, such as gentle, persuasive approaches, which are person-centred care strategies that emphasize understanding and empathy.

“How do I help that nurse understand what’s happening and give them practical tips to help them through that interaction with a patient when they’re struggling?” Rubel explains.

Policy development and research keep Rubel busy, too. It’s “bigger picture” work that many hospitals don’t have anyone to tackle. Some organizations are downsizing clinical nurse specialist roles, Rubel says. “But to see Niagara Health investing in these roles, there’s evidence to support they can enhance practice.”

Niagara is home to one of the oldest populations in Canada and the number of older adults living in the region is expected to double in the next 20 years, making her role even more essential.

 “I’ve been here since 2010 with GAP and we really are seeing significant growth in all facets of geriatrics,” Rubel says. “It’s something positive and it’s exciting to be part of an organization that values care for older adults, and when me make concrete investments in that over time, it shows we’re committed to providing that care.”

Rubel has been committed to caring for older adults since doing a high school co-op placement in a retirement home where she worked with an activities director implementing programming for residents with dementia.

She always knew she wanted to be a nurse but that experience convinced her gerontological nursing was her calling.

Field of opportunities

In her first year of studies at McMaster University, she was the only one of 100 fresh-faced students to raise their hands when asked about going into the specialty. As a result, opportunities abounded with plenty of mentors wanting to help her along the way.

Rubel loved the complexity of caring for older adults, the teams-based approach, getting to know patients’ families, and even the autonomy the less-beaten nursing career path offered.

Her dedication to caring for older adults extends beyond her role at Niagara Health. She is president of the Canadian Gerontological Nursing Association and recently wrapped up a four-year term with the Registered Nurses’ Association of Ontario board of directors. Both taught her about advocacy and the political side of nursing, and connected her with more mentors.

Rubel jokes she could talk about geriatrics all day.

“It’s cool to share with other people that these opportunities in nursing exist. I was lucky to be introduced to these opportunities early in my career and really embrace them,” she says. “Not all (nursing) specialties face the same challenges with recruitment that gerontological nursing does, but I do think gerontological nursing is in a really interesting time. We’re seeing more of a shift in the population toward older adults with an aging population.”

That means a field rife with prospects and a mentor in Rubel, who would be happy to show new nurses the joy that gerontological nursing could bring. 

“You know when you’re in the right place at the right time?” she asks. “This is where it’s at and it’s a great feeling.”



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