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Getting off the merry-go-round: Actionable change for social care nursing

What needs to happen to improve the profile of nursing in adult social care? Richard Adams and Joanne Bosanquet MBE, who have both worked in the nursing sector for many years, outline four key recommendations aimed at addressing the current problems.

Time for action, not just reflection

For those of us who have worked in the sector for some time, we are well aware of the various calls to action to improve the profile of nursing in adult social care. These calls have had a particular focus on care homes. The authors of this article have been involved in a number of roundtable conversations, reference groups, research projects and individual initiatives, all aimed at addressing this issue. Whilst these endeavours offer a solid foundation for identifying why nurses in adult social care feel such disparity with NHS colleagues, and many recommendations to address the problem are proposed, there is, seemingly, very little tangible action and the most common response remains that ‘it’s complex’.

A recent roundtable hosted by Nursing in Practice <1>, with a number of representatives from the sector, highlighted some areas where changes could be made but left us wondering what needs to be in place for these frequently called upon recommendations to become actions embedded in practice.

In this article, we reflect on some of the actions that have been proposed through the various forums, including student nurse placements, developing career pathways, ensuring that nurses in social care are connected to one another and how nurses in the sector can influence decision-making at local, regional and national levels. Our aim is to suggest some practical steps that nurses in adult social care can take to start to bring about sustainable change.

Student placements

Our starting point is the same as that of many nurses – our undergraduate experiences. A nurse’s perception of adult social care is seeded very early on in their career. We all have stories to tell of students (and, in fact, experienced nurses) leaving hospital-based settings for community-based settings, with worries about becoming de-skilled and careers being stifled – or worse, over. Whilst this is patently not true, it is a myth that persists. How often do we hear of students’ shoulders slumping when they find out their next placement is in a care home? It is vital we start to work to combat this. In England, we have an incentive. Our Government is focusing on expanding placements as part of its policy work on recruitment and retention of the nursing workforce <2>.

We must understand what expectations the students have of their placements and have a plan for how these can be met. There is a wealth of information on what makes for a good placement <3>. We need to explore this, look at the areas of best practice for welcoming students, familiarise them with the care home environment and find the best ways of supporting them on their placement.

Reaching out to university placement officers and Skills for Care (and equivalent in devolved nations) regional locality managers and developing a relationship with them will help both the university and the care home to develop the placement offering so that students get the most out of placements in each part of their programme.

Most importantly, students on placements in care homes need to be exposed to the richness of experiences from working as nurses in adult social care: being immersed in relationship-centred care, being part of MDT meetings, taking part in quality improvement projects and practising their management skills – not just being seen as another pair of hands or a distraction.

Career pathways

Having provided a positive student experience, we need to be able to recruit and retain our newly registered nurses, as well as attracting nurses further on in their careers into the sector. There is a perception that persists that there is no career pathway for nurses working in adult social care. Experience and research show this is not the case. Care home nursing requires highly developed leadership and influencing skills <4>. Nurses in social care work at many levels in care home (groups) and supporting organisations, from registered nurse roles working on care units, right the way through to CEOs (as is the case for both the authors of this article): the breadth and scope of roles in the sector is considerable, including clinical, quality improvement, education, research and management roles. One example is Dr Karen Rennie <5>, who completed her PhD as an early career nurse and is a care home nurse and lecturer in Scotland.

Whilst structural career pathways are not always well articulated within the sector, there are some excellent examples of career pathways starting to emerge (for example, at the Erskine Trust <6>). We are not always good at seeing things that are not presented to us, so it is vital that we improve the ways in which we talk about and demonstrate to people outside of the sector what careers in adult social care look like and shout about the development opportunities that exist.

There is a need for a more powerful narrative through personal, powerful and authentic stories in our own voices: not just the voices of senior people but the voices of nurses in all parts of the sector. Such stories should help to assuage the concerns of nurses further on in their careers who may have qualms about joining the sector and reduce the perceived risks of leaving the safety of the NHS. Fear of the unknown can be a barrier to nurses moving into the sector. The more we tell our stories – the more the unknown becomes known.

Connecting senior nurses to one another

The power of stories connects people to one another. Recently, we all acquired a shared story of nursing through a pandemic. Prior to this happening, it felt like there was a disconnect between nurse leaders in the sector and senior nurses in other parts of the profession <7>. It is easy to speculate on the reasons for this, not least how the careers of each are developed in isolation of one another. However, we need to be honest with ourselves: how hard do we try to reach out and make connections – both within the sector and outside of it, and across the system?

Much of the funding for the development of nurse leaders either does not apply or does not actively encourage applicants from the sector. Instead, it tends to focus on those providing NHS services, which makes developing connections more difficult. We need to explore the leadership programmes that are available and look at how we can be part of these, as well as how to develop our own programmes across the sector. There are some opportunities, such as those provided by the Foundation of Nursing Studies <8> and, more recently, The King’s Fund <9>. Yet, despite this, we need to find a way to make connections across a wider spectrum of the profession.

Both authors have the privilege of being Florence Nightingale Foundation Alumni. We also benefit from being part of a wider network of nurses and being connected to different parts of the profession. These networks give us a voice, both as individuals and collectively, and this is probably not exploited enough by our sector.

Influencing decision making

Having a voice is important. Care homes are part of the health and social care system but are often seen as a problem to be fixed, rather than being a partner with an equal contribution to make to the local health economy. Nurses outside of the sector lack a clear understanding of the differences between residents and nursing homes, or those units within the same home: in the same way, we could not claim to understand how a hospital works. However, because of this lack of understanding, there is a risk that we end up being endlessly done unto, rather than leading the change we need to see.

We have a new Chief Nurse for Adult Social Care, which gives us a figurehead, but one person cannot ‘fix’ all the problems in the system. This role is only part of the solution, not the whole solution. We need a more collective voice which doesn’t rely on key individuals, other groups or organisations to speak for us.

Care home nurses need to influence the system. We need to be part of local networks, not just attending but actively participating in the decision making. We also need to have reach across the profession, raising the issues that affect us and challenging the unconscious bias held by policy and decision makers where care home nursing is concerned. We need to make sure that adult social care is better represented in academia, research, policy and strategic planning, as well as in practice. We need to make sure our voice is heard at the highest levels.

Finding our voice

Our aim at the start of this article was to look at some of the calls to action that keep being repeated over the years at roundtables, reference groups and stakeholder meetings. We have explored four key themes that continue to emerge time and again, and the recommendations associated with them. Our aim has been to suggest some positive action that we can take as care home nurses to translate these recommendations into tangible action. We hold the view that we need to act for ourselves and not wait for someone else to do this for us.

We have covered a scale of practice starting with student nurses, looking at career development, focusing on making connections across the profession and finishing with finding our voice. We finish with a further call to action. We are a country with an ageing population and one with increasing care needs. We are the experts in the care of older people. Perhaps now is the time for us to develop a group for care home nurses, run by care home nurses, which can be a voice that speaks to – and for – us?

If ever there was a time to find our voices, that time is now.

Joanne Bosanquet MBE RN RHV is the Chief Executive of the Foundation of Nursing Studies and Richard Adams is the Chief Executive of Sears Healthcare Ltd. Email: Twitter: @MrsBosanquet Email:  Twitter: @RichAdams_RN.

Are you actively involved in transforming the picture of adult social care nursing? How have you helped to call for action and what would your comments be on the action points outlined in this article? Share your comments below on the feature.


  2. Clinical Placements Expansion Programme (nursing, midwifery and allied health professionals AHPs) | Health Education England (
  3. Laugaland, K., Kaldestad, K., Espeland, E. et al. (2021) Nursing students’ experience with clinical placement in nursing homes: a focus group study. BMC Nurs 20, 159.
  4. Havig, A.K., Skogstad, A., Kjekshus, L.E., and Romøren, T.I. (2011) Leadership, staffing and quality of care in nursing homes. BMC Health Services Research, 11(327). Available online at:
  6. Baron, D.T. (2019) An Unknown World, British Geriatrics Society.
  9. Cascading Leadership | The King’s Fund (

About Joanne Bosanquet MBE RN RHV

Joanne has been a Registered Nurse for over 30 years. Joanne has worked in a number of sectors and has developed her career based on values of person-centredness and person-centred workplace cultures….

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Joanne was appointed as the Chief Executive at the Foundation of Nursing Studies in 2019 and is thoroughly enjoying building networks and collaborating with colleagues throughout the charity sector. Joanne says, ‘it is a very generous sector, bursting with integrity, authentic leadership, support and ingenuity to solve problems together’. Joanne wouldn’t be anywhere else!

About Richard Adams

Richard Adams began his career as a care assistant aged 17, qualifying as a nurse in 2003. Moving into the health and social care sector in 2009, Richard has worked in a number of governance and opera…

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tional roles. He joined Bupa Care Services in 2013 as Head of Quality, moving to the Director of Care and Quality role in 2015. Richard was later appointed Chief Nurse for Bupa UK encompassing nurses working in care homes, an acute hospital, primary care and telemedicine practice settings

Richard was appointed CEO of Sears Healthcare in September 2018, a new care home provider delivering resid ential, nursing and dementia across the South West.

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