Registered nurses in a local authority care home

Some registered nurses are working in a local authority–run care home, supporting residents with complex and often changing health needs. Nurses work closely with residents, families, care staff, GPs and wider community services, with a strong emphasis on continuity, professional judgement and values-led care. 

Nurses described leadership that is experienced through trust, autonomy and support, rather than constant oversight. They are trusted to make professional decisions about residents’ care, including when to monitor deterioration, when to escalate to GPs, and when to involve emergency or specialist services.

This approach enables nurses to practise confidently and responsibly, drawing on clinical expertise, risk assessment and professional accountability, rather than being restricted to task-based or protocol-driven roles. Nurses know that their judgement is respected and that support is available when complex decisions need to be shared.

A strong sense of belonging comes from working in a setting where nurses have time to build long-term relationships with residents, families and colleagues. Knowing residents well, and being known and trusted by families, creates continuity, shared understanding and more confident decision-making.

Nurses described feeling part of a stable professional community, rather than working in fast-turnover environments where relationships are brief and fragmented. This sense of connection was a key reason nurses chose to stay.

Wellbeing was closely linked to pace, continuity and professional containment - meaning nurses felt that complex clinical risk and emotional strain were supported by visible leadership, shared decision-making and clear governance, rather than carried alone. Compared with hospital settings, nurses valued having time to think, reflect and make decisions without constant pressure to move on to the next patient.

Working within a local authority was also seen as offering broader organisational support, including access to corporate services, internal networks and professional colleagues beyond the care home. This contributed to feeling supported as a practitioner, not just as a member of a single service.

Nurses were clear that while some hospital-based clinical tasks are used less frequently, their roles require high-level skill and judgement every day. This includes comprehensive assessment, clinical decision-making, managing uncertainty, communicating with families about complex or sensitive issues, and coordinating care across multiple professionals and services.

There was recognition that nursing-specific clinical development opportunities within local authorities can be more limited and often rely on external providers. Where councils actively support access to external training, regional nursing networks or advanced practice development, this was seen as strengthening confidence, professional identity and retention.

Flexibility was experienced through autonomy in practice and trusted decision-making. Nurses valued being able to respond to residents’ needs in a personalised way, informed by deep knowledge of individuals’ wishes, preferences and life histories.

Working in a local authority care home also offered greater stability and predictability than agency or more fragmented roles, supporting longer-term commitment and sustainable working patterns.

Nurses spoke openly about the lack of positive narratives about care home nursing, despite the responsibility, autonomy and relational depth involved. While pay pressures affect retention across the system, local authority roles were often seen as offering more secure terms and conditions than private sector alternatives.

Where nurses felt their expertise and judgement were recognised, for example through visible leadership support, inclusion in workforce conversations, or involvement in service development, this strongly reinforced their decision to remain in post.

Retention in local authority care home nursing is strengthened when nurses

• are trusted to exercise professional judgement through values-led leadership
• feel a strong sense of belonging through continuity and relationships
• experience wellbeing through manageable pace and organisational support
• can grow professionally through meaningful use of advanced skills and access to development
• have flexibility and autonomy in how they practise
• see their role positively recognised and valued

Addressing gaps in nursing-specific development opportunities, and amplifying positive narratives about care home nursing, represent clear opportunities to strengthen retention further.

Local authorities looking to strengthen retention of registered nurses in care homes can draw on the following learning from this practice example.

• Create leadership conditions that trust nurses to exercise professional judgement, particularly in managing deterioration, escalation and end-of-life care.
• Ensure senior leaders are visible and accessible, reinforcing that nurses are supported when making complex or high-risk decisions.
• Avoid over-protocolisation of care that reduces nursing roles to task completion rather than professional practice.

• Actively broker access to nursing-specific clinical development, including external training, regional networks or advanced practice pathways.
• Recognise and name the advanced skills nurses already use daily, including assessment, risk management, complex decision-making and family communication.
• Ensure nursing roles are included explicitly in workforce development and CPD planning, rather than assumed to be covered by generic training offers.

• Protect manageable pace and continuity as core features of care home nursing roles.
• Enable access to wider local authority support functions and professional networks to reduce isolation and strengthen containment.
• Recognise that stability and predictability are retention factors, particularly when compared with agency or fragmented employment models.

• Actively challenge negative or absent narratives about care home nursing by sharing positive examples internally and externally.
• Involve nurses in service development, quality improvement and workforce conversations to reinforce professional visibility.
• Treat recognition as a practical lever, not just a cultural aspiration.