Nursing Careers and “The Silver Tsunami”, The Nurse Keith Show, EPS 14

In 2015, we can clearly see that our population is getting older at an exponential rate. According to the U.S. Department of Health and Human Services’ Administration on Aging, there were 39.6 million Americans aged 65 or older in 2009, approximately 13% of the total population of the country. By 2030, it’s projected that the number of Americans 65 or older will be approximately 72 million, almost double the 2009 figure, and this will be almost 19% of the population.

Taking the significant growth of the population of older Americans into account, the career opportunities for nurses are absolutely tremendous. So, if you’re a nurse or nurse entrepreneur geared towards working with your elders, things are looking very bright indeed!

Nurse with elder

The Silver Tsunami

“The Silver Tsunami” is a term that’s been in use for a number of years now, and it refers to the wave of Baby Boomers that’s currently break upon our collective shores as they reach retirement age, and this wave will last a very long time. This is no small demographic shift, and it’s implications for healthcare are beyond measure, even as everyone tries to measure it.

For us nurses or nurse entrepreneurs, this tsunami is an opportunity, and we can ride this wave if we’re moved to do so.

We Nurses Have What Baby Boomers Want

The Baby Boom Generation is beginning to leave the workforce in earnest, and their retirement years will be spent in a variety of circumstances.

This particular generation is generally well-educated, and they probably have the highest expectations of any generation in history in terms of what they want.

While not every Baby Boomer is wealthy, there’s a relative level of financial stability among the members this generation, and they’re probably pretty prepared for what’s coming, with long term care insurance and IRAs that will help get them through the tough times.

This generation wants to be comfortable, they want to live independently at home as long as possible, and many would probably prefer to die at home, too. And in order to do this, they need savvy healthcare professionals who can deliver these types of services, and that’s where you come in.

The Nurse Can Deliver

When it comes to aging Americans, nurses who’d like to remain working in traditional clinical settings like long term care, ambulatory surgery centers, home care, hospice, and assisted living will do very well in terms of jobs in the years to come. Such facilities will continue to hire nurses as the census of elderly Americans increases, and as the need for particular services mushrooms.

Regarding dementia care, including but not limited to Alzheimer’s, the need for these specialized services is definitely going to continue to increase. Nurses who develop expertise in dementia, Alzheimer’s, and the cognitive changes of aging will be in high demand.

Meanwhile, as people live longer, there’s more need for joint replacement surgeries, rehabilitation, and all manner of interventions that necessitate nurses being part of the plan of care. And when those lives begin to draw to a close, various forms of palliative and hospice care also come into play.

So, nurses, if you have any interest in geriatrics, now’s the time to act.

The Practical and the Registered Nurse

Even though the Institute of Medicine has recommended that the majority of nurses be Bachelor’s-prepared by 2020, there are still opportunities for practical nurses in long term care, skilled nursing facilities, assisted living, and other environments. And even though there’s continued discussion about doing away altogether with LPNs and Associate-level nurses in favor of nurses with Bachelor’s degrees, it’ll be much longer than we think before these positions completely disappear from the healthcare landscape.

Meanwhile, we need to acknowledge that some facilities and employers are taking the Institute of Medicine seriously, and we’re beginning to see employers that no longer hire nurses who have don’t have a Bachelor’s.

So, in my way of thinking, earning a Bachelor’s of Science in Nursing will be money well spent in the 21st century, and I recommend that you nurses who lack one consider the possibility, especially if you want as many doors open to you as possible.

 Advanced Practice Nursing

If you’re interested in advanced practice nursing, training as a Nurse Practitioner (NP) or Doctor of Nursing Practice (DNP) with a focus on geriatrics would serve you very well over the next few decades.

It’s very apparent that nurses with advanced practice training have increasing levels of autonomy in many states, and some legislation is making it easier for these highly trained nurses to practice without the direct supervision of a physician.

Bear in mind that there is an ongoing shortage of primary care physicians in this country as doctors move towards more well-paying areas of specialty practice. Thus, demand for nurse practitioners with specialization in geriatric medicine is growing, and nurses who’d like to step into these roles will be well-positioned to do just that.

The Nurse Entrepreneur’s Field Day

As opportunities for traditional geriatric nursing will continue to expand, so will opportunities for those nurses who have an interest in hanging a shingle as a nurse entrepreneur.

Over on RNFM Radio, we’ve talked a fair amount about concierge nursing, where nurses are providing private services to patients and clients who can’t be bothered with the insurance system and the limitations of physician-based medicine.

Concierge medicine has already taken off, and concierge nursing is also on the runway, yet still in its infancy. Basically, concierge nurses—whether they’re advanced practice nurses or those with lesser degrees—can start a business that provides home-based nursing services to clients willing to pay a fee to receive those services. Some concierge nurses work with physicians, but some are realizing that there’s plenty that they can do without a physician while remaining within their scope of practice.

There are nurses offering private geriatric case management, telephone-based geriatric health coaching services, and who knows what else smart nurses will continue to come up with as they strive to meet the needs of the aging population?

A Potential Scenario

Marsha is 80 years old, lives alone in Pueblo, Colorado, and her son and daughter both live on the East Coast. Marsha can still drive, but her kids know that that won’t last forever. She can cook for herself, but she’s beginning to feel overwhelmed by her medications, the recommendations of her doctors, and the general management of her health and healthcare. She frequently forgets to refill her prescriptions, and she can’t adjust to prefilling a pill box, even though she forgets to take 30% of her medications each week.

Enter a local concierge geriatric nurse case manager. John is a Registered Nurse in Pueblo, and he recently opened a business under his own LLC, providing specialty case management for frail elders who live within 75 miles of his home office.

For a monthly fee, John provides a specific set of services, including prescription management, med box prefills, coordination of care, and he’ll even accompany clients to their medical appointments, if necessary. John employs a second nurse to help him cover the phones, so there’s a nurse available to his clients 24 hours a day, 365 days a year.

Once a week, John Skypes or chats by phone with one or both of Marsha’s children. John uses an online platform where he can track his clients, and where their children can log in to check on their parents’ progress, see when John is scheduled to stop by the house, and send John messages. If their schedules allow, John will Skype with Marsha’s children from her house during his visits so that Marsha can chat with her children while John is assessing her, and any concerns or issues can be addressed then and there.

Although John doesn’t accept insurance, some insurance companies are actually interested in covering this type of care, but John also sees that his clients and their families would rather not have an insurance company dictating what John can and cannot do. There are plenty of families willing to pay John’s very reasonable fees, and his services give them peace of mind while keeping the older generation much healthier and out of the hospital.

Hop Aboard The Silver Tsunami Express

How the healthcare industry will continue to respond to the aging population isn’t entirely clear, but was is clear is that this generation entering their golden years is savvy, and they know what they want. For those with the means, the ability to pay for concierge nursing services is a no-brainer, so nurse entrepreneurs can easily fulfill that need with services that match the demands of consumers.

For nurses remaining in more traditional roles, there are also plenty of opportunities, and we can only hope that innovations in the care of elderly patients will drive the efficiency and quality of care consistently in an upward direction.

Nurses, if you have any interest in geriatric nursing, you can carve yourself a nitch in the hospital, long term care, private physician offices, ambulatory surgery centers, and many other types of facilities and practices. And if you want to venture out on your own, there’s also an enormous audience for what you have to offer.

Mind you, on some level, we’re venturing into uncharted territory, so some of you will be blazing new trails and offering services in a way that have yet to be invented. But don’t worry about that. Consumers will sometimes drive the creation of new types of products or services based on what they’re asking for.

On the other hand, we sometimes have to create products or services that the consumer doesn’t even know they need yet. Remember the birth of the personal computer or the smart phone? We didn’t know we needed those things, but once we had them, we couldn’t imagine life without them. Certain types of healthcare-related services are the same way. Have the courage to create a new niche, product, or service, and the reaction to what you’ve created may surprise you.

So, if you’re interested in geriatrics and the care of an aging population, hop aboard The Silver Tsunami Express and hear the whistle blowin’ in the wind!

Please consider leaving a review of The Nurse Keith Show over on iTunes; this helps more nurses and healthcare professionals find the show and benefit from the information being shared. Just visit iTunes, click on the iTunes store, search for The Nurse Keith Show under podcasts, and leave a review, and voila. Thanks!

Be well, dig deep, and keep in touch!


Nurse Keith photoKeith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind and the well-known blog, Digital Doorway.

Keith is co-host of, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses. Keith is also the resident nursing career expert at

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century.” He has also contributed chapters to a number of books related to the nursing profession, and currently writes for MultiViews New Service,, StaffGarden, and Working Nurse Magazine.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, holistic career coach, writer, and well-known successful nurse entrepreneur.



Nursing Careers and “The Silver Tsunami”, The Nurse Keith Show, EPS 14 — 8 Comments

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