‘We need an older people’s specialist nurse – with separate registration status’

Expecting current pre-reg nurse education to cover ageing population's range of need is unrealistic, says Dementia UK director
Nurse with older patient

Expecting current pre-reg nurse education to cover ageing population's range of need is unrealistic, says Dementia UK director

Is older people's nursing best served by having its own registration status? Picture: SPL

An ageing society requires the creation of the older people’s specialist nurse with separate registration status, a leading nurse believes.

Dementia UK director of clinical services Paul Edwards wants to revive the idea, which was recommended in the Francis Report of 2013 but rejected by the Nursing and Midwifery Council (NMC) and the government.

Myriad health complexities

Mr Edwards says: ‘There’s a growing expectation on nurses to deal with myriad health complexities, such as dementia, which comes with an ageing society.

‘It is unrealistic to think the range, level and variations of health and social needs can be absorbed into the current pre-registration programmes.

Paul Edwards, clinical services
director of Dementia UK

‘If we are serious about improving health, safety and well-being, then we need to have a different response to older people’s nursing – and in particular dementia care nursing – from pretending we can somehow “bolt on” these issues to current, already-full university curriculums.’

The children’s nurse education model

He would like to see a separate registration created initially through postgraduate training, but with a view to developing pre-registration courses, much like those for the specialist children’s nurse.

The Francis report, commissioned following the Mid Staffordshire NHS Foundation Trust care scandal, recommended: ‘The special requirements of caring for the elderly should be recognised by consideration of the introduction of a new status of a registered older person’s nurse.’

But in its response to the Francis report, the NMC stated: ‘All nurses… need to be better trained and prepared to deal with the particular needs of older and more vulnerable patients, not just a group of nurses with specialist registration status.’

A 2016 National Audit Office report found 62% of hospital bed days in 2014-15 were occupied by people aged 65 and over. It further found an 18% rise in emergency admissions of older people between 2010-11 and 2014-15, against a 12% rise for the whole population.

Knowledge ‘built in’ to NMC standards

Following Francis, the NMC said the knowledge required in older person’s care would be built into new education standards, which it went on to publish this year.

A spokesperson for the regulator told Nursing Older People: ‘We recognise that people are living longer and this may mean they develop multiple health needs.

‘Our new education standards for nurses ensure they have the knowledge and skills to deliver healthcare to people who have complex mental, physical, cognitive and behavioural care needs.

‘This includes meeting the health and care needs for older people across a range of settings including those living with dementia, and for people at the end of their life.’

Variability of university programmes

King’s College Hospital NHS Foundation Trust nurse consultant for older people Nicky Hayes believes these standards could have gone further, with variation between university programmes her main concern.

Nicky Hayes, nurse consultant
for older people at King's College

‘Education providers have flexibility to deliver the curriculum and this has led to variability in the extent to which healthcare needs of older people have been integrated into students’ learning,’ she said.

Ms Hayes, who is consultant editor of Nursing Older People, has called for an ‘overhaul’ of the pre-registration curriculum to ensure it provides appropriate coverage of ageing.

Although she believes the moment has passed for a specialist registration of older person’s nurse, she wants to see further post-registration training to enable nurses to better support and care for older people.

She said: ‘For post-registration, there is a need for clinical leadership in older person’s care, supported by postgraduate training. I’m the clinical lead for the Older Persons Fellowship at King’s College London, where we provide a master’s-level programme for nurses and therapists in older person’s care.’

Development of leadership roles

The Health Education England-funded programme enables fellows to take the quality improvement programmes they develop during the course across England, and Ms Hayes wants further opportunities for the rest of the UK.

She added: ‘I would also like to see more investment in post-registration programmes that are linked to leadership development, so that practitioners who have the interest in and ability to care for older people can progress to leadership roles.

‘Underpinning this is raising the standard of profession-wide knowledge and skills in older adult’s care, which will ensure we can all care for older people.’

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