Gerontological nursing: professional priority or eternal Cinderella?

Over thirty years ago geriatric nursing, as it was then called, was at the forefront of nursing research in the United Kingdom. Concurrent with the emergence of geriatric medicine as a distinct speciality, the pioneering study of Doreen Norton and colleagues (Norton et al. 1962) served to highlight both the deficits that existed in the hospital care of older people and the enormous potential of nursing to improve the situation, particularly for the ‘irremediable’ patient (Norton 1965). Caring for those who could not be cured but required on-going support was seen to constitute ‘true nursing’ and was identified as an area of practice in which nurses should excel (Norton 1965, Wells 1980).

Such potential went largely unrealised, however, as nursing focused on acute, hospital-based care (Nolan 1994). As a consequence, those working in continuing care struggled to find value in their work and patients were subjected to ‘aimless residual care’ (Evers 1991), a situation exacerbated by the continued application of the biomedical model (Reed and Watson 1994). Despite claims that nurses working with older people have ‘special skills’ (Royal College of Nursing 1993), the nature of such skills has therefore never fully been explicated. Indeed, Armstrong-Esther et al. (1994) asked what nurses currently contribute to the well-being of elderly people and, following their study, suggested that nurses must take the initiative and expand their role if ‘we are going to avoid simply warehousing the elderly until they die’. The need to act is particularly pressing at present as the spectre of ‘bed-blockers’ emerges once more and there is growing professional concern that older people may soon be denied the right to receive care from a qualified nurse (Nursing Times 1996).