A geriatric nurse is a registered nurse who specializes in caring for older adults, typically those 65 and older. Sometimes called a gerontological nurse, this specialty focuses on the unique health challenges that come with aging: managing multiple chronic conditions, preventing falls, addressing cognitive decline, and helping patients maintain their quality of life for as long as possible. The American Nurses Association first recognized geriatric nursing as a distinct specialty in the 1960s, and the field has grown steadily as the older adult population expands.
What Geriatric Nurses Actually Do
The day-to-day work of a geriatric nurse revolves around assessment, care coordination, and a deep familiarity with each patient’s full picture. On a typical morning, a geriatric nurse practitioner in a long-term care facility might review lab results, check in on residents whose conditions have changed, and conduct routine wellness exams. Unit nurses observe subtle shifts in a resident’s behavior or physical status and flag them for the care team. This kind of close monitoring is central to the role because older adults often present symptoms differently than younger patients.
One responsibility that sets geriatric nursing apart is medication management. Older adults frequently take multiple prescriptions for overlapping chronic conditions, a situation known as polypharmacy. Geriatric nurses routinely review medication lists, watching for side effects that could cause confusion, dizziness, or functional decline. De-prescribing, the process of reducing medications to the minimum needed to control disease, is a common practice. Geriatric nurse practitioners work alongside physicians to trim unnecessary drugs and maximize quality of life.
Beyond clinical tasks, geriatric nurses invest time in learning about their patients as people: their family situations, goals, support systems, and personal values. This matters because care decisions for older adults often involve trade-offs between aggressive treatment and comfort, and understanding what a patient actually wants shapes every recommendation.
Health Conditions They Manage
Geriatric nurses focus on a cluster of interrelated health problems sometimes called geriatric syndromes. These include falls, delirium (sudden confusion), urinary incontinence, pressure ulcers, frailty, and functional decline. What makes these conditions tricky is that they share overlapping risk factors: cognitive impairment, reduced mobility, and the use of multiple medications all increase the likelihood of several syndromes at once.
Falls are a major focus. Risk factors include prior fall history, use of a walking aid, dementia, low activity levels, and balance problems. Geriatric nurses assess these risks, coordinate physical therapy, and adjust medications that might contribute to unsteadiness. Delirium prevention is another priority. Hospital-based programs led by nurses have been shown to reduce both delirium episodes and functional decline in older patients by targeting factors like dehydration, sleep disruption, and psychoactive drug use.
Dementia care runs through much of the specialty. Geriatric nurses help manage behavioral symptoms, support families navigating a loved one’s cognitive decline, and advocate for care approaches centered on the person rather than the disease.
Where Geriatric Nurses Work
Geriatric nurses practice across a wide range of settings. The most common include:
- Residential care: Nursing homes, assisted living facilities, and memory care units. These settings emphasize long-term relationships with residents and often use person-centered care models designed to improve well-being and reduce behavioral symptoms.
- Home and community-based care: Home health agencies, adult day programs, and primary care clinics. Nurses in these roles focus on helping older adults manage their health independently, which has been linked to lower hospitalization rates and reduced treatment burden.
- Acute care: Hospitals, especially emergency departments and medical-surgical units where older patients are common. Here, geriatric nurses help prevent complications like delirium and falls during a hospital stay.
- Hospice and palliative care: Supporting patients and families through end-of-life decisions and comfort-focused treatment.
Core Skills and Competencies
Geriatric nursing demands a specific skill set that goes beyond general nursing knowledge. A validation study identified nine key domains of competence: communication, ethics, direct care for older adults, safety and quality, family and caregiver support, interdisciplinary collaboration, health promotion and disease prevention, management, and professional development. Of these, direct care for older adults contained the most individual competencies, reflecting how broad and nuanced this work is.
Communication skills are particularly important. Older adults may have hearing loss, vision changes, or cognitive impairment that makes standard patient education ineffective. Geriatric nurses adapt their approach accordingly. They also spend significant time communicating with family members who are often deeply involved in care decisions and may be providing care at home themselves. Palliative care conversations, where nurses help patients and families think through goals and wishes for serious illness, require both clinical knowledge and emotional sensitivity.
Collaboration is built into the role. Geriatric nurses regularly work alongside physicians, social workers, physical and occupational therapists, and other specialists. In primary care, nurses and social workers sometimes conduct joint patient assessments. The geriatric nurse ensures accountability by systematically reviewing cases with the broader team and helping decide on next steps.
How to Become a Geriatric Nurse
The entry point is a registered nursing license, earned through either an associate’s or bachelor’s degree in nursing. From there, nurses can pursue board certification in gerontological nursing through the American Nurses Credentialing Center. The credential is called GERO-BC (Gerontological Nurse, Board Certified).
To qualify for the certification exam, you need at least two years of full-time RN experience, a minimum of 2,000 hours of clinical practice in gerontological nursing within the past three years, and 30 hours of continuing education in the specialty within the same timeframe. The exam itself is 150 questions with a three-hour time limit. Certification is valid for five years and requires ongoing professional development to renew.
Nurses who want to practice at a more advanced level can become geriatric nurse practitioners by completing a master’s or doctoral nursing program with a gerontology focus. Nurse practitioners can diagnose conditions, prescribe medications, and lead care independently or alongside physicians. This distinction matters in settings like nursing homes, where a geriatric nurse practitioner may serve as the primary provider for dozens of residents.
Salary and Job Outlook
Geriatric nurses at the RN level earn salaries in line with the general registered nursing workforce, which varies by location, experience, and care setting. For nurse practitioners specializing in geriatrics, the Bureau of Labor Statistics reports a median annual salary of $129,210 as of 2024. Those who work as temporary or traveling practitioners can earn higher hourly rates, averaging around $92 per hour.
Demand for geriatric nursing expertise is strong. The population of adults 65 and older is the fastest-growing age group in the United States, and the health system needs nurses who understand how aging changes the way diseases present, how medications interact in older bodies, and how to keep people functioning well at home for as long as possible. Geriatric nurses work at the center of that challenge.