Recruiting and retaining the right care home nurses in order to tackle the social care crisis: by Lindsay Dingwall, Clinical/Academic Nurse Consultant for Older People at the University of Dundee and Lead Educator of the Care Home Nursing: Changing Perceptions course.
We already know that there is a crisis in nurse recruitment in the NHS, but care homes especially, are losing out in the race to recruit registered nurses with the best knowledge, skills and talent. Ironically, if care homes close, aside from some of the most vulnerable people in our society being denied the care they need, the NHS also suffers. So why are care home nurses not more valued?
Care home work can still be viewed as undesirable and unskilled; notably not by care home nurses who elect to practice in care homes. They recognise that they are skilled nurses who work autonomously to deliver complex, and at times highly specialist, care. These are the nurses who must take up the gauntlet of “selling” care home careers to nursing students.
The use of technology in acute hospitals is commonly viewed as skilled care: but the skill comes from the practitioner’s knowledge and experience of when and how to use technology to save lives. Nursing students learn to value this “scientific” care over the “art” of nursing from different sources – the public fascination with emergency drama, driven by the media, other nursing professionals in their pre-registration programmes, and admittedly, from some care home placements. Nursing students still report after specialist older people placements that they did not use their technical skills and so they did not learn.
Preparing care home nurses for the job 
Nurse education must shift from focusing on medical models of acute in-patient care, to preparing nurses for the evolving health and social care landscape. Care home nurses and nurse educators must work together to develop placement experiences for nursing students that build on their theoretical and practical knowledge. Placements should demonstrate the complexity, not just of health and social care delivery, but the physical, psychological, social and spiritual complexity of each resident.
To attract future nurses, care home nurses and educators need to invest time and expertise in teaching nursing students that the art of nursing, those hidden and often undervalued skills, is integral to the best healthcare experiences and quality of life, not just of residents but of nurses themselves.
Nurses in care homes require a breadth of nursing knowledge and skills that reflect current developments in health and social care. They require skills from a diverse range of specialities: medical skills to manage cardiac and respiratory conditions; community skills to help people live with long term conditions like diabetes and Parkinson’s Disease, palliative and end of life care skills and mental health skills. They are required to demonstrate leadership and critical thinking, often without the same access to immediate support that hospital nurses may have. In fact, often during the immediate onset of a resident’s health deteriorating, or a crisis in staffing or in the care home environment, the care home nurse is the sole decision maker with the accountability and responsibility for these initial decisions.
Small positive changes made within care home environments can impact on every person’s lives and nurses have the flexibility to make these changes. Care home nurses, far from losing their skills have the opportunity to develop rewarding careers. The relationships developed within the “family” of the care home may be reward enough for some. Other care homes nurses may progress towards more senior posts or into clinical leadership and education.
Care home nurses must be vocal about the rewarding nature of the job, the high level of responsibility and the opportunities for career progression. Care home work involves looking after those with some of the most complex care needs and care home nurses are real nurses who are educated, artful, innovative, resourceful and passionate.
For more information on training for care home nurses, see dundee.ac.uk
