Within the context of the literature this area is under investigated. Understanding how leadership is reflected in the role of Consultant Nurses is complex as Consultant Nurses work across traditional interfaces and between different levels within organizations. Consultant Nurses have been 'challenged' to identify the 'difference' they are making; to do this it is important to understand how leadership (as one element) is reflected in a highly complex, multidimensional role and the links between leadership and enabling, quality person-centred ways of working with Older People within rapidly changing, pressurized healthcare settings.

Background and aim Nurse vacancy rates in older adult services are disproportionately high compared to other areas of nursing. This is partly because few student nurses consider it an attractive career option once qualified due to perceptions of low‐status, strenuous nature of the work and impoverished care environments. The study aimed to explore students' perceptions of incentives that could counterbalance the barriers for new graduate nurses joining this speciality. Methods A qualitative descriptive design using focus group interviews was carried out with six groups of student nurses (n = 27) following completion of their acute care older adult placements in three hospitals. Data were analysed using thematic analysis. Results The barriers from students' perspectives were constructed as a vicious cycle of staff shortages and inadequate resources that created impoverished environments leading to a dissonance between ideal and delivered care. Over one‐third of students were unlikely to consider a career in older adults nursing, but the remaining students could identify incentives that may tempt them. Four main themes and eight subthemes were identified: gerontological status and leadership (ward leadership; respected others); relational care (legitimising emotional support, care vs. cure goals); quality work environment (pay as recognition, 12‐hr shifts); and education‐career pathways (gerontological knowledge, career progression). Conclusion Radical new approaches, based on student and nurse engagement, are required to incentivise a career in gerontological nursing. A combination of shorter and longer term strategies that include education‐career pathways, a focus on relation care, and improved work conditions including financial incentives should be trialled. Implications for practice In terms of practice, addressing high nurse vacancy rates in older adult services that negaively impacts on patient outcomes requires a suite of incentives informed by ‘what matters’ to students and nurses working in the speciality.

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This article outlines the health needs of older nursing home residents and identifies the case for the role of an older people's specialist nurse within a multidisciplinary care homes support team (CHST). This model has been successfully introduced in the London boroughs of Lambeth, Southwark and Lewisham as a response to the profile of local health need among care home residents and changes in national policy such as the introduction of NHS-funding nursing care. The structure of the CHST is described, and the older people's specialist nurse is discussed in detail. The emergent role of the older people's specialist nurse as key to managing the interface between the nursing homes and primary care is highlighted as a key benefit of this unique role.