‘Outstanding nurses work with older people across all settings’

Nicky Hayes explains why caring for the frailest older people can be immensely rewarding but needs to be underpinned by structured career pathways

Nicky Hayes explains why caring for the frailest older people can be immensely rewarding but needs to be underpinned by structured career pathways

Nicky Hayes (centre) with colleagues.
Picture: Charles Milligan

This article sets the scene for a series of features in Nursing Older People that showcase careers in nursing older adults.

Featuring a variety of jobs and settings, the series explores the pathways that these nurses took, what inspired and inspires them, and the future potential for nurses who might want to follow in their footsteps.

Many outstanding nurses work with older adults across the NHS, independent and voluntary sectors, in a wide range of roles, all making a difference to the health and lives of older adults, and this series will provide a sample of the best.

The demand for nursing exceeds supply, especially in older adults’ care. It’s therefore essential that employers offer opportunities for nursing career pathways that incentivise nurses to enter the specialty and to remain in it.

NHS vacancies for nurses, midwives and allied health professionals stand at almost 42,000 (9%), and the independent sector fares no better. This is partly due to historic trends in commissioning nurse education, particularly during 2009-12.


Other contributory factors include: changes in working patterns; changing guidance on staffing ratios stemming from the 2013 Francis report into the events at Mid Staffordshire NHS Foundation Trust; the increase in the total UK population; and increased longevity and frailty. Bearing in mind that about 10% of people aged over 65 years and 25%-50% of those aged over 85 years exhibit signs of frailty, such as falls, immobility, delirium, incontinence and susceptibility to side effects of medication (Clegg et al 2013), and in 2016 there were already 571,245 people aged 90 and over living in the UK (Office for National Statistics 2017), the drivers for national and local support for careers in nursing older people have never been stronger.


people aged 90 and over in the UK 

Office for National Statistics

Retention of the existing workforce is also an ongoing cause for concern. The percentage of nurses leaving the NHS for reasons other than retirement increased from 7% in 2011-12 to 9% in 2016-17 (Health Education England 2017). Incentives to stay in nursing, and, in particular, nursing older adults, include pay, working conditions and support, as well as appropriate training and development.

Caring for the frailest people with complex needs can be immensely challenging and rewarding, but it does need to be underpinned by opportunities to develop the appropriate knowledge and skills in effective management of frailty, prevention of ill health in later life and high-quality care at the end of life. Nurses also need to feel empowered to apply models of comprehensive assessment and to work as equal partners in the interprofessional team. The challenge is to embed the fundamental knowledge and skills to care for older adults into roles at all levels and across all sectors, thus building the blocks to support career pathways.     

Care of older people is now emerging from a historic and negative image of lower status, undervalued and hard work. As you will read in our careers features, today’s practitioners feel far more empowered and valued, with recognition of the skill with which they blend knowledge about ageing and healthcare, frailty and complex needs with core nursing skills of patient-centred, compassionate care.

Ongoing gaps

Our features explore the routes by which nurses arrived into their roles, in the process exposing some ongoing gaps in career structures for nurses who wish to specialise in older adults’ care. These gaps need to be closed and although models of support, such as career coaching and self-assessment resources, are under development by bodies such as Health Education England they are still in their infancy, needing further development and commissioning from education providers.


of nurses left the profession for reasons other than retirement in 2016-17

Health Education England

Older adults’ nursing needs far more structured career pathways with funded access to education in ageing and healthcare, clinical skills development and clinical leadership. This applies to existing and new roles such as nursing associates and apprenticeships that are broadening the entry to nursing careers.

It is to be hoped that the new roles will lead to career choices in older adults’ care and enable practitioners to deploy their skills at the bedside, in research, education and service development, and in clinical leadership roles in healthcare of older adults.

In our first feature we hear from two advanced nurse practitioners who discuss the complexities of caring for older people in acute hospital settings. You can read it here

What knowledge and skills could I acquire in a career in caring for older adults?

  • A thorough understanding of the ageing process and its application to physical and mental health, illness and well-being
  • Knowledge of frailty and comprehensive assessment of the older adult
  • Skills in working as part of an interprofessional team
  • Skills in integrated care and managing patients with complex needs
  • For advanced roles, skills in advanced physical assessment of the older adult and independent prescribing

Where are the job opportunities for nursing older people?

Community: supporting people living with frailty and long-term conditions is a mainstay of community nursing, with opportunities now ranging from nursing assistant up to community matron or frailty specialist with a focus on older adults. Integrated teams such as rapid response, hospital at home and supported discharge all include nursing roles that focus on older adults. 

Hospitals: many NHS hospitals are developing their older adult services to focus on identification of frailty and acute management of older people with complex needs. Nursing assistants, apprentices and healthcare assistants can expect to be provided with in-house training and opportunities to undertake training up to professional entry level. Opportunities for registered nurses include specialist frailty practitioners, advanced nurse practitioners and nurse consultants.

Social care sector: working with older adults in care homes is a rewarding, challenging and responsible role for nurses. Care homes are increasingly providing sub-acute and intermediate care, as well as managing palliative and end-of-life care for older people with complex needs.  

Education, research and development: ageing is a booming area for research, with funding available for postgraduate scholarship and bespoke research projects from organisations such as the National Institute for Health Research and charities such as the Burdett Trust for Nursing.


Clegg A, Young J, Iliffe S et al (2013) Frailty in elderly people. The Lancet. 

Health Education England (2017) Facing the Facts, Shaping the Future. A Draft Health and Care Workforce Strategy for England to 2027. 

Office for National Statistics (2017) Estimates of the Very Old (Including Centenarians): 2002 to 2016.

Nicky Hayes is consultant editor, Nursing Older People and nurse consultant, King’s College Hospital NHS Foundation Trust, London

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