Nursing care for older people has faced many challenges over the last few years, not least from several critical reports calling for improved standards of care.
These have tended to compound, rather than solve, problems of poor image, low levels of recruitment, and inadequate staffing levels and skill mix. If standards of care in older people’s services and the associated “nursing expertise” lag behind other areas, the reasons are embedded in chronic under-recognition and funding coupled with the sector’s complexity, diversity and needs.
Growing awareness of older people’s right to expect high-quality care is welcome but past drivers for change have been overwhelmingly negative – no wonder nurses caring for older people feel bruised rather than valued. The challenge today is not convincing experienced nurses that caring for older people can be fulfilling, but rather, attracting them to the speciality by promoting a more positive image and offering career advancement opportunities supported by appropriate academic pathways.
The work can be demanding but those who do it describe it as the essence of nursing care, highlighting the privilege they feel and the trust and bond that grows between them and their clients. The Royal College of Nursing’s work on safe staffing for older people’s wards reported that work with this client group brings “personal enjoyment and satisfaction […] tempered by the challenge of meeting complex needs within a system under pressure”.
Fortunately we are now seeing less endemic, societal ageism and more positive recognition of older people’s right to appropriate, high-quality services. Models of comprehensive assessment and integrated working are emerging, championed by bodies such as the British Geriatrics Society and RCN. These, together with the NHS’s Five Year Forward View strategy, offer approaches to meet complex health and social care needs, and outline how health services can meet the needs of an ageing population and tackle financial challenges.
The nursing profession is responding to the challenge but needs to develop a strong evidence base on supporting older people to live with dignity and the complexity of ageing. It requires defined education and career pathways, and visible nurse leadership. Career pathways that enable nurses to consolidate and extend their roles up to consultant level could help enormously in incentivising nurses, but these need to be developed and commissioned with some degree of standardisation nationwide.
We are still awaiting the revolution, but positive progress has been made. Health Education England has commissioned The Older People’s Nurse Fellowship, a national programme run at King’s College London for clinical leaders. This helps nurses move from outdated models to the current comprehensive assessment for older people.
This will greatly strengthen our resource to improve standards of care and support appropriate service development locally and nationally, but we need a long-term, sustained commitment to more strategies to drive quality improvement and make services fit for purpose for older people.
A new era in healthcare is emerging, with an emphasis on community care and managing high levels of complexity, competing risk and benefits without the immediate back-up of large hospital teams. Nurses are at the forefront of this service modernisation and most users are older people. A national strategy and local action is needed to address the development of skills, knowledge and career pathways to attract and retain highly capable and motivated people to meet this demand.
Nicky Hayes is consultant nurse for older people, King’s College Hospital Foundation Trust, and lecturer/practitioner, King’s College London, Corina Naughton is senior lecturer, King’s College London