Geriatric nurses care for adults aged 65 and older across a broad spectrum of settings — skilled nursing facilities, PACE programs, memory care units, outpatient geriatric clinics, and private homes. The specialty demands clinical depth in chronic disease management, polypharmacy, dementia care, functional decline, and end-of-life transitions that are unique to aging populations. To enter the specialty, you need an RN license and relevant clinical experience; the voluntary GERO-BC certification from ANCC formalizes that expertise.
This guide covers what geriatric nursing looks like day to day, the step-by-step pathway into the specialty, GERO-BC and AGCNS-BC certification requirements verified from ANCC, the full range of work settings, and the key clinical competencies — dementia, polypharmacy, fall prevention — that define the work.
At a glance
| Requirement | Details |
|---|---|
| Minimum education | Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) |
| Licensure | Active, unencumbered RN license (NCLEX-RN) |
| Clinical experience | 2 years full-time RN practice; 2,000 hours in gerontological nursing (within last 3 years) for GERO-BC |
| Continuing education | 30 hours in gerontological nursing within the last 3 years (GERO-BC requirement) |
| Specialty certification | GERO-BC (ANCC) — voluntary, 5-year credential for RNs; AGCNS-BC (ANCC) for CNS track |
| Work settings | SNFs, memory care/ALF, PACE programs, hospital geriatric units, home health, outpatient geriatric clinics, hospice |
| Salary range | $72,000–$103,000+ depending on setting, state, and experience (see companion salary guide) |
Step-by-step pathway
The path into geriatric nursing follows the standard RN licensure route, then builds specialty experience before any certification is pursued.
Step 1: Complete an ADN or BSN program. Both degrees qualify you to sit for the NCLEX-RN. A BSN is increasingly preferred by hospital geriatric units and PACE programs; some larger organizations require it for case manager or lead roles. Community college ADN programs remain widely accepted, particularly in SNF and long-term care settings. For a full overview of RN education options, see the BSN guide or the ADN guide.
Step 2: Pass NCLEX-RN and obtain your RN license. Licensure is required in every state. Endorsement rules vary — if you plan to work across state lines (common in home health and PACE), confirm reciprocity requirements for your target states.
Step 3: Build relevant clinical experience. Most geriatric RN positions require 1–2 years of prior RN experience. The most relevant backgrounds are medical-surgical nursing (broad clinical foundation), long-term care or SNF nursing (direct exposure to elderly populations and dementia), oncology (symptom management, end-of-life care), or home health nursing (autonomous practice, chronic care management). See the home health nurse guide for that pathway.
Step 4: Pursue a geriatric nursing role. With 1–2 years of experience, you can apply directly to SNF nurse, memory care RN, hospital geriatric unit, or PACE program nurse positions. Most employers provide a structured orientation period.
Step 5: Accumulate GERO-BC eligibility hours. GERO-BC requires 2,000 hours of gerontological nursing clinical practice within the last 3 years — roughly 12–15 months of full-time work in geriatric settings. You will also need 30 continuing education hours in gerontological nursing during the same window.
Step 6: Sit for GERO-BC (optional but recommended). Apply through ANCC (nursingworld.org). The exam consists of 150 questions (125 scored, 25 pretest items) with a 3-hour time limit. The credential is valid for 5 years.
Step 7 (advanced practice): Pursue MSN/CNS track and AGCNS-BC if you are targeting clinical nurse specialist roles in geriatrics. This requires a graduate degree from an AGCNS-accredited program and 500 supervised clinical hours.
GERO-BC certification (ANCC)
The Gerontological Nursing Certification (GERO-BC™) is issued by the American Nurses Credentialing Center (ANCC) and is the primary specialty credential for RNs practicing in geriatric nursing. It is voluntary, not required for employment, but is associated with stronger negotiating position and greater role eligibility.
Eligibility requirements
All four criteria must be met at time of application (source: ANCC, nursingworld.org):
- Active RN license — current, unencumbered RN license in a U.S. state or territory (or the legal equivalent in another country)
- RN practice — the equivalent of 2 years full-time as a registered nurse
- Gerontological clinical hours — minimum 2,000 hours of clinical practice in the specialty area of gerontological nursing within the last 3 years
- Continuing education — 30 hours of continuing education in gerontological nursing within the last 3 years
Exam details
| Detail | Specification |
|---|---|
| Questions | 150 total — 125 scored, 25 unscored pretest items |
| Time allowed | 3 hours |
| Passing score | Minimum scaled score of 350 out of 500 |
| Exam fee (non-ANA member) | $395 |
| Exam fee (ANA member) | $295 |
| Renewal fee (non-member) | $350 |
| Renewal fee (ANA member) | $250 |
| Credential validity | 5 years |
| Testing format | Computer-based exam (Prometric test centers and remote proctored) |
Content domains
The GERO-BC exam covers three content domains:
- Assessment and Diagnosis — comprehensive geriatric assessment, geriatric syndromes (dementia, delirium, falls, incontinence, polypharmacy, pressure injuries, depression), functional status, and care planning
- Planning, Implementation, and Evaluation — individualized care planning, evidence-based interventions, medication management, care transitions, family and caregiver support
- Professional Foundation — ethics, legal and regulatory issues, care coordination, interdisciplinary team practice, patient advocacy
Renewal
The GERO-BC credential is valid for 5 years. Renewal requires maintaining an active RN license and completing specified professional development activities during the certification period. ANCC offers both a continuing education/practice hour pathway and an examination retake pathway for renewal.
AGCNS-BC: the CNS track in adult-gerontology
The Adult-Gerontology Clinical Nurse Specialist (AGCNS-BC) credential from ANCC is the advanced practice certification for nurses in the CNS track who specialize in adult and gerontological populations. This is a graduate-level credential — it requires an MSN or DNP.
How it differs from GERO-BC
| Dimension | GERO-BC | AGCNS-BC |
|---|---|---|
| Who it is for | RNs practicing in gerontological settings | Clinical nurse specialists in adult-gerontology practice |
| Education required | ADN or BSN | MSN or DNP from an AGCNS-accredited program (CCNE, ACEN, or NLN CNEA) |
| Clinical hours required | 2,000 in gerontological nursing (last 3 years) | 500 faculty-supervised clinical hours within AGCNS program |
| Graduate coursework | Not required | Advanced pharmacology, advanced health assessment, advanced physiology/pathophysiology |
| Scope | RN specialty practice credential | Advanced practice — system/population-level practice, research translation, staff education |
| Credential validity | 5 years | 5 years |
| Issuing body | ANCC | ANCC |
Note on GCNS-BC: ANCC previously offered a Gerontological Clinical Nurse Specialist (GCNS-BC) certification. That credential is now renewal-only — ANCC no longer offers it to new applicants. The current CNS-track credential in this population is the AGCNS-BC.
For nurses interested in the advanced practice pathway, the MSN guide covers program types, costs, and timelines.
Work settings for geriatric nurses
Geriatric nursing is one of the most setting-diverse specialties in nursing. The same clinical expertise applies across seven distinct care environments.
| Setting | What the work looks like | Key clinical features |
|---|---|---|
| Skilled nursing facility (SNF) | 24-hour nursing care for post-acute rehab patients and long-term care residents; RNs manage the full clinical team and handle medication management, wound care, and care planning | High medication complexity, dementia care, pressure injury prevention, regulatory documentation (MDS assessments) |
| Memory care / assisted living facility (ALF) | Specialized residential care for residents with Alzheimer's or other dementias; RNs provide clinical oversight and manage behavioral and safety interventions | Behavioral symptom management, wandering safety protocols, family communication, restraint alternatives |
| PACE program (Program of All-Inclusive Care for the Elderly) | Community-based managed care model integrating medical, rehabilitative, and social services for frail elderly who qualify for nursing home care but choose to live at home; RNs serve on the interdisciplinary team | Comprehensive geriatric assessment, care coordination, community-based frail elderly, Medicare/Medicaid managed care |
| Hospital geriatric unit / GEMU | Specialized inpatient unit for elderly patients using the Acute Care for Elders (ACE) model; focuses on preventing hospital-acquired functional decline | Delirium prevention and management, mobility programs, polypharmacy review, early discharge planning |
| Home health | RNs visit homebound elderly patients for skilled nursing services — wound care, IV therapy, medication management, chronic disease monitoring; see [home health nurse guide](/guides/how-to-become-a-home-health-nurse/) | OASIS-E documentation, autonomous clinical decision-making, fall risk assessment in home environment, caregiver coaching |
| Outpatient geriatric clinic | Ambulatory clinic focused on comprehensive geriatric assessments, chronic disease management, and care transitions for complex elderly patients referred by primary care | Comprehensive geriatric assessment (CGA), cognitive screening, functional assessment, medication reconciliation |
| Hospice / palliative care | Comfort-focused care for elderly patients with terminal diagnoses; RNs provide symptom management, family support, and end-of-life care; see [hospice nurse guide](/guides/how-to-become-a-hospice-nurse/) | Pain and symptom management, active dying recognition, family caregiver support, medication protocols |
What geriatric nurses do day to day
The clinical work of a geriatric nurse is organized around a set of competencies that cut across all the settings above. These are not interchangeable with general medical-surgical nursing — they require specific training and sustained practice to do well.
Comprehensive geriatric assessment
Geriatric nurses perform structured multi-domain assessments that go well beyond the standard nursing admission assessment. A comprehensive geriatric assessment (CGA) evaluates:
- Cognitive status — standardized tools including the Mini-Cog, Montreal Cognitive Assessment (MoCA), or MMSE; baseline documentation is critical for detecting delirium
- Functional status — Activities of Daily Living (ADLs: bathing, dressing, toileting, transferring, continence, feeding) and Instrumental ADLs (IADLs: managing finances, medications, transportation, housekeeping)
- Fall risk — Timed Up and Go (TUG) test, Berg Balance Scale, review of medications contributing to fall risk (diuretics, antihypertensives, benzodiazepines, sedating antihistamines, anticholinergics)
- Nutritional status — Mini Nutritional Assessment (MNA), body weight trends, dysphagia screening
- Social support and caregiver burden — who provides care, what is the caregiver’s capacity, what resources are in place
- Mood and affect — Geriatric Depression Scale (GDS), PHQ-9, behavioral symptoms of dementia
Polypharmacy management
Adults aged 65 and older use disproportionately more medications than younger populations. Studies consistently show that more than 40% of older Americans take five or more prescription medications simultaneously — a threshold often defined as polypharmacy. Geriatric nurses are trained to apply the Beers Criteria (American Geriatrics Society) to identify potentially inappropriate medications in older adults, flag drug-drug interactions, and communicate findings to prescribers.
Common medication classes requiring close monitoring in elderly patients: anticholinergics (cognitive effects, urinary retention, constipation), long-acting benzodiazepines (fall risk, respiratory depression), NSAIDs (renal toxicity, GI bleeding, cardiovascular risk), sliding-scale insulin (hypoglycemia), and high-dose antihypertensives (orthostatic hypotension, syncope).
Dementia and delirium care
Distinguishing dementia from delirium — and recognizing when both are present simultaneously — is one of the most clinically demanding skills in geriatric nursing. Dementia is a chronic, progressive cognitive decline; delirium is an acute change in consciousness and cognition with an underlying medical cause. The two frequently co-occur, and delirium superimposed on dementia (DSD) is associated with significantly worse outcomes, including accelerated cognitive decline and increased mortality.
Geriatric nurses use the Confusion Assessment Method (CAM) to assess for delirium, identify and address precipitating factors (infection, medication changes, dehydration, pain, urinary retention, environmental disruption), and implement non-pharmacological reorientation strategies. Pharmacological management of delirium is typically a last resort given the risks in elderly patients.
For dementia care, the clinical competencies extend to behavioral and psychological symptoms of dementia (BPSD) — agitation, wandering, sundowning, sleep disturbance, and psychosis. Person-centered care approaches and structured environmental modifications are first-line interventions before any pharmacological management. For a detailed clinical reference on Alzheimer’s disease nursing, see Alzheimer’s disease nursing.
Fall prevention
Falls are the leading cause of injury-related mortality in adults over 65. Geriatric nurses implement individualized fall prevention programs that include bed and chair alarms, non-skid footwear, environment modification, scheduled toileting, structured mobility programs, medication review (particularly for fall-risk drugs), and physical therapy referrals. Documentation of fall risk assessment and interventions is both a clinical and regulatory requirement in most settings.
Care planning and care transitions
Geriatric nurses develop individualized care plans that integrate clinical findings, patient preferences, functional goals, and family input. In SNF and PACE settings, the care plan is a regulatory document reviewed on specified intervals. Transitions of care — from hospital to SNF, SNF to home, or home to hospice — are high-risk periods for elderly patients, and geriatric nurses coordinate these transitions, reconcile medications, and communicate with receiving providers.
Geriatric nursing vs other specialties
| Dimension | Geriatric nursing | ICU / critical care | Oncology | Home health |
|---|---|---|---|---|
| Patient relationship duration | Weeks to years (especially SNF, PACE, memory care) | Days to weeks | Weeks to months during treatment | Weeks to months per episode |
| Care focus | Chronic disease management, functional maintenance, quality of life, end-of-life transitions | Acute physiological stabilization | Disease-directed treatment and symptom management | Skilled care in the home, chronic disease monitoring |
| Family and caregiver role | Central — caregiver burden, decision-making capacity, guardianship considerations are core clinical issues | Present but not primary clinical focus | Significant but treatment-directed | Significant — caregiver coaching is a core nursing task |
| End-of-life care | Frequent — goals-of-care conversations, hospice transitions, and death are routine | Present but not the defining clinical frame | Present in advanced disease | Present in terminal home health patients |
| Pace | Sustained and relational — geriatric nursing involves knowing the patient over time | High intensity, rapid response | Treatment-cycle rhythm | Episodic visit model |
The defining feature of geriatric nursing compared to most other specialties is the combination of long-term relationships, chronic complexity, and the clinical and ethical weight of progressive decline. Nurses who find meaning in following patients through years of a chronic trajectory — and who are equipped to have goals-of-care conversations, support caregivers, and navigate end-of-life decisions — tend to stay in geriatric nursing long term.
Professional organizations and resources
American Geriatrics Society (AGS) — The leading clinical organization for healthcare professionals in geriatrics. AGS publishes the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, the AGS Clinical Practice Guidelines, and a range of geriatric clinical tools. Website: americangeriatrics.org.
National Gerontological Nursing Association (NGNA) — The professional home for gerontological nurses. NGNA provides clinical education, certification preparation resources, and the NGNA Geriatric Nursing Practice Guidelines. Website: ngna.org.
American Nurses Credentialing Center (ANCC) — Issues the GERO-BC and AGCNS-BC credentials. The ANCC certification page at nursingworld.org is the authoritative source for current eligibility requirements and fees.
Gerontological Advanced Practice Nurses Association (GAPNA) — Focused on advanced practice nurses (NPs and CNSs) in gerontological settings. Provides clinical education and certification guidance for the AGPCNP-BC and AGCNS-BC credentials.
Hartford Institute for Geriatric Nursing (NYU) — ConsultGeri and Try This: clinical resources including standardized assessment tools, best practice protocols, and geriatric nursing education resources. Website: hign.org.
FAQ
Do you need a certification to work as a geriatric nurse? No. GERO-BC certification is voluntary. You can work as a geriatric nurse with only an active RN license and relevant clinical experience. Certification demonstrates specialty expertise, may support salary negotiation, and is required or preferred for some leadership and advanced clinical roles — but it is not a prerequisite for entry-level geriatric nursing positions.
Can an LPN become a geriatric nurse? Yes. Licensed Practical Nurses work extensively in geriatric settings — particularly SNFs, assisted living facilities, and long-term care — in supportive roles under RN and physician supervision. LPN scope of practice in geriatric settings covers medication administration, wound care, vital signs monitoring, and basic clinical assessment within the LPN’s state scope. ANCC’s GERO-BC certification is specific to registered nurses; LPNs do not currently have a separate ANCC gerontological certification pathway.
What is the difference between geriatric nursing and gerontological nursing? The terms are used interchangeably in clinical practice and in certification names. “Gerontological nursing” is the formal academic and certification terminology (the ANCC credential is GERO-BC, short for Gerontological Nursing Board Certified). “Geriatric nursing” is the more commonly used colloquial term. Both refer to the same specialty: nursing care focused on the health and wellbeing of older adults.
Is geriatric nursing a growing field? Yes, substantially. The U.S. Census Bureau projects that adults aged 65 and older will represent 20% of the U.S. population by 2030 — approximately 72 million people — up from 54 million in 2019. The oldest-old population (85+), who have the highest rates of dementia, functional limitation, and multi-morbidity, is the fastest-growing age cohort. BLS projects employment of registered nurses overall to grow 6% from 2023 to 2033, and demand for geriatric specialty nurses is expected to outpace that projection given population aging trends.
What do geriatric nurses earn? Geriatric nurse salary varies substantially by setting, state, and experience. The BLS national RN median across all settings is $86,070 (May 2024). Geriatric specialty data from multiple sources puts the range at roughly $72,000–$103,000 for staff RNs, with California, Hawaii, and Oregon at the top of the state range. For the full breakdown, see the geriatric nurse salary guide.
How long does it take to become a geriatric nurse? The typical timeline from starting nursing school to a geriatric nursing role is 4–6 years: 2 years for an ADN (or 4 years for a BSN), plus 1–2 years of clinical experience to meet most employers’ experience requirements. GERO-BC certification eligibility requires an additional 2,000 hours of gerontological clinical practice — approximately 12–15 months of full-time geriatric nursing work.
What makes a good geriatric nurse? The clinical competencies — comprehensive assessment, polypharmacy management, dementia care, fall prevention — are learnable. What is harder to develop is the relational orientation. Geriatric nursing involves patients who decline over time, caregivers who are exhausted and often grieving in advance, and clinical decisions made in the context of what the patient values rather than what medicine can technically achieve. Nurses who are comfortable sitting with complexity, who can hold the clinical and the human simultaneously, and who find meaning in long-term relationships rather than acute interventions tend to thrive. Those who need clear physiological improvement as clinical feedback rarely stay.
Are there travel nursing positions for geriatric nurses? Yes. SNF travel nursing is a real market segment, driven by staffing shortages at skilled nursing facilities nationally. Travel SNF RN contracts are placed by major agencies (AMN Healthcare, Aya Healthcare, Vivian Health) at 13-week intervals. Average SNF travel rates are comparable to general travel nursing — Vivian Health reports SNF RNs earn approximately $47.86/hour on average, with the highest-volume travel markets in New York, Washington, and Wisconsin. Memory care and ALF facilities less commonly use travel nurses, but PACE program RN positions are occasionally available through travel agencies.