The challenge of attracting students to older people's nursing

This feature in our careers series hears from a newly qualified nurse who is working with older people and explores opportunities in education, research and development

This feature in our careers series hears from a newly qualified nurse who is working with older people and explores opportunities in education, research and development

Catherine Burn: 'you need communication and interpersonal skills'. Picture: Jim Varney

Juliana Thompson

‘Placements in the care and voluntary sectors can change perceptions about older people’s nursing’

Adult nursing lecturer Juliana Thompson says she had an epiphany about becoming an older people’s nurse after a 15-year accountancy career.

‘I was always attracted to older people’s nursing, but my family steered me away from it as perhaps it wasn’t seen by them as a “proper profession” to pursue in the 1980s,’ she says.

'Through working with an older person, you are contributing to their continuity of life'

‘I’m from a working-class upbringing and I was the first person in my family to study for a degree.’

Dr Thompson studied for a master’s degree in English literature before becoming an accountant and then training to be a nurse. ‘I didn’t start my nurse training until 2007 and I was a mature student. I wanted to work in care homes because I’ve always enjoyed being with older people. Most of them have lived fascinating lives although we see them in a vulnerable stage.

'Through working with an older person, you are contributing to their continuity of life.’

Juliana Thompson. Picture: Jim Varney

When she learned there were graduate tutor roles available at Northumbria University Dr Thompson jumped at the opportunity.

‘I was able to study for a PhD at the same time, which was about the role and status of nurses who work in care homes.’

Dr Thompson has been involved in several strands of research that have been published in a variety of journals. She was one of the lead authors of a study published last year about the work identity of nursing home nurses.

The study, which involved interviews with 13 nurses across seven nursing homes in north-east England, found that participants felt isolated and excluded from the rest of the healthcare workforce.

Recruitment challenge

Dr Thompson says that attracting nurses into the care home sector and developing nurses who want to move away from the NHS can be a challenge.

‘There are at times organisational issues between primary and secondary care for older people and there are still concerns around older people’s nurses accessing education to gain further skills in the private sector,’ she says.

‘Managers in the care sector know workforce development is important and what they need to realise is that it must be the right quality of education. Simply doing an online course may not be enough.

‘In education we can influence the next generation of nurses, we can offer modules in pre-registration courses and continuing professional development around enhancing care for older people. Placements in the care and voluntary sectors can also serve to change perceptions about the field.’

Northumbria University facilitates lectures from older people and carers who talk to nursing students about their experiences. Older people also participate in role play with students where they might, for example, act as a person with dementia and offer feedback to students about how it felt to be in their care.

‘It is still the case that new nursing students may believe that working with older people is about personal care rather than clinical care,’ says Dr Thompson.

‘It’s our job to demonstrate that looking after older people is complex, from thinking about dementia and end of life care to the transfer of care between primary, secondary and private sectors and the challenges of systems to provide more integrated health and social care.’

Catherine Burn

‘It is so much more than looking after the physical needs of older people’

Catherine Burn qualified as a nurse in September 2017 and was taught by Dr Thompson.

She works in rehabilitation services for older people at the Newcastle upon Tyne Hospitals NHS Foundation Trust and describes her university placement at a nursing home as invaluable.

‘I always wanted to work with older people and a module as part of my nursing course made up my mind. As a nursing student having a placement in a nursing home provided opportunities to understand the complexities of the modern health and social care system.

Different viewpoint

‘It allowed us to grasp the challenges of caring for older people from a different point of view to that of a nurse in a hospital. I can understand the pressures that nursing homes are under, and hopefully placements like the one I did will lead to a better working relationship between hospitals and community services.

‘The placement provided an opportunity to work with older people’s nurse specialists, research nurses and members of the clinical commissioning group, which highlighted the vast opportunities for career development in the field.’

Catherine Burn. Picture: Jim Varney

Ms Burn also had a nursing home management placement in her third year which gave her the chance to apply theory to practice, developing therapeutic relationships to help plan individualised care, and manage residents’ complex needs such as comorbidities and frailty.

Part of the management placement explored delegation and managing teams, which provided an excellent starting point to develop skills in those areas.

‘The challenges in the sector are unique and it is so much more than looking after the physical needs of older people; you have to look at them holistically and be creative in working with the person and exploring all the options of how best to help them.’

Case-by-case basis

Every week she takes part in multidisciplinary team (MDT) meetings: ‘We look at each person on a case-by-case basis and assess their goals. It is a good environment for building relationships among the different professions and to see how and if the patient is improving.

‘I’m working as part of a strong team and can ask anyone anything and not be laughed at'

‘After the MDT meeting we finish any outstanding jobs before providing feedback to the doctors and then handing over.

‘I’m working as part of a strong team and can ask anyone anything and not be laughed at.

‘One patient who had been in hospital for a while said she wanted to go home, but we needed to think of a solution in relation to her continence and if she should have a catheter, continence pads or an overnight carer.

‘She eventually decided she wanted to go home with a catheter and it was rewarding to see a decision made and her discharge.’

Ms Burn says she loves her job but admits the increasing ageing population and lack of beds in older people’s rehabilitation are challenging because patients may have to stay on acute wards.

‘It can be frustrating. If, as a sector, we can manage older people’s long term needs we might not need as many acute beds and they could be managed in the community.

‘To any students who are unsure about older people’s nursing I would say don’t judge what other people say, come and experience it for yourself.

Juliana Thompson attending a feedback review with volunteer Lorna Kennedy and students
​​​​​Picture: Jim Varney

‘The field requires unique skills and as a student you may hear others talking about intravenous therapy or drains, but a key element of what you need to work with older people is communication and interpersonal skills.

Motivation skills

‘Older people may be in the acute sector longer than other patients and it is important to keep them motivated. They may come in and say: “I wish they’d left me on the floor,” but it is about motivating them to see the progress made. That takes a lot of skill.

‘You can’t put a price on the joy of seeing someone develop from not wanting to do anything for themselves to asking to get up, have meals and move about on their own.’

A workforce competency framework for care homes

Newcastle Gateshead Clinical Commissioning Group commissioned Northumbria University to develop a workforce competency framework for enhanced health in care homes.

An initial study in 2016 suggested a need for a workforce competency framework that was standardised and integrated, specific to the needs of residents and covered the whole workforce from those providing essential care to specialist and advanced practice.

In developing the framework, the researchers said that emphasis on competency rather than on role allowed the framework to be standardised and flexible.

The workforce competency framework requires the whole workforce to develop competencies in:

  • Values and attitudes.
  • Workforce collaboration, co-operation and support.
  • Leading, organising, managing and improving care. 
  • Knowledge and skills for care delivery.

The researchers are in the process of adapting the framework to widen its use beyond care homes as it is relevant to the care of all older people with complex needs. They have recently completed a pilot study gap analysis using the competency framework, along with a study exploring the barriers to developing competency, particularly across sectors. The results will be published shortly.

Find out more

Thompson J, Tiplady S, McNall A et al (2018) A workforce competency framework for enhanced health. Nursing & Residential Care. 20, 4, 153-157.



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