Colleagues, friends and family often share their stories of health care gone right or—more commonly—gone wrong with me. Their stories illustrate our global needs for a nurse workforce prepared and competent to care for older people. Those who reach out to me begin by saying ‘let me tell you what happened, Sarah’ in an ominous tone. Then they pose simple questions that should not need to be asked. ‘How could this happen? ‘How can they treat me this way?’ ‘Why did this happen to me (or to the person I love)?’ My answers are paltry responses to their plight.

We gerontological nurses know well the concerns these stories express and much more. Nascent solutions are at hand but a question we commonly ask ourselves obscures them from view. What question you ask? This one—‘how can we encourage our students to choose careers working with older people?’ Around the world, we talk about encouraging these careers. We study our students' preferences and ultimate choices. Yet we keep returning to the question. This question seems never to fade, despite having been partly answered in various ways, because it belies an insidious half-truth. We hold a misguided conviction that nurses do indeed have a choice about whether to work with older people or not. The stories told to me create a far different narrative.

Nurses do have a choice about the extent to which we work with older people. We can choose to specialise in care for older people, settings where all our patients and clients are chronologically older. We who make that choice are gerontological nurses, the professional community addressed by this, the International Journal of Older People Nursing (IJOPN) since its inception. Nonetheless, nurses who do not choose gerontological nursing will still work with and care for older people. To do so well, they must be specifically competent, steering clear of hackneyed notions that simply caring for older people results in effective, evidence-based care that meets the needs and expectations of the people receiving it.

Most career choices entailing care for older people are made by default when nurses choose a job by specialty or care setting. One nurse happens to get a job in a nursing home and loves it. Another nurse quietly admits to themselves ‘I do not wish to work with older people’ and seeks a position on an adult surgical ward. Both end up working largely with older people, both by default and one against their desires. Ultimately, the truth is nurses currently think they choose whether to work with older people. They do so, however, without adequate knowledge and understanding of what effective, evidence-based care for older people entails.

The extent to which all nursing involves older people spans the specialised to the generalist and on to the supportive. We gerontological nurses are the specialists. Nurses who practice in adult settings including most chronic disease specialties, almost all adult hospital wards, home care, and much of primary care are the generalists. Nurses who work in supportive domains are those colleagues practicing in maternal–child and paediatric settings where older people appear only as caregivers. Here, contact with older caregivers appears inconsequential but, in reality, frequently helps assure the health and well-being of entire families. As a result, proposing that nurses can elect specialties and settings where they can wholly avoid working with older people is simultaneously ageist and untrue. To promulgate this ageist fiction profoundly undermines our social contract.

The implicit ageism of our focus on promoting careers in older people nursing arises in the suggestion that avoiding older people is somehow acceptable. Older people are part of every family and every community around the world. Older people are patients, caregivers, or both in every healthcare setting. Nursing, like other health professions, then inadvertently endorses the ambivalent structural ageism that is common across societies when we say ‘choose to work with older people’. No, you can choose to specialise in gerontological nursing, but you cannot avoid working with older people.

Our current position on choosing to work with older people suggests that only those making the choice of gerontological nursing need education to improve their relevant knowledge and skills. Those who inadvertently care for older people do so because some or all patients they care for are chronologically old in a setting that declares a specialty other than that of care for older people. They are then expected to provide adequate care just by applying the standards of that specialty. We typically ignore education to shift attitudes and behaviours under the assumption that those who make the choice already hold necessary attitudes and express appropriate behaviours. Simultaneously, we gerontological nurses too often neglect the age-related educational needs of everyone not making the choice for gerontological nursing, leaving their attitudes, behaviours, knowledge, and skills to the teaching of others. The result? Persistent structural ageism in health care with higher costs, lower quality, and dissatisfying experiences for all—nurses, their patients, and their caregivers and families alike. We need a new approach to ensuring global nursing workforce needs in are fully met.

Typically, nursing, like the societies in which we live, views ageing populations as adding burden to workloads and creating clinical problems which only some colleagues choose to face. In truth, the problem exists not among older people or in the ageing process. The problem represented by poor healthcare experiences and suboptimal outcomes for older people as well as subpar caregiving support arises in the structural ageism within our education, our health systems, our profession, and those of our fellow healthcare professions. The problem rests with us. Actively dismantling structural and individual ageism is the starting point for fundamental education necessary to all nurses and all healthcare workers.

Ageism, in all its myriad forms and in interactions with healthism, ableism, and all forms of social discrimination, is endemic around the world. Ageism proves especially problematic in health care. Many forces contribute to ageism in health care. Nurses and other healthcare workers frequently encounter extreme situations which then begin to feel normative. Encountering older patients in dire health circumstances often enough prompts us to believe that all older people face such situations. Insidiously, we begin to see all older people as frail and ill, stripped of capacity and function. We too quickly see older people as leading meaningless lives save for the mere virtue of having attained their advanced chronological age. Unfortunately, nursing education does little to redress this situation. Our education promotes our compassion and develops caretaking to a level where we too easily strip agency and identity albeit with beneficent intent. In the end, we persist in seeing the older person from our collective vantage point as only a nameless elder facing the usual predicament. We become ambivalently ageist, doing for older people and not with them. Consequently, we repeatedly miss moral and ethical imperatives to support their personhood, understand their perspective, and partner with them in the manner they desire.

A new system of education in nursing, one that dismantles ageism and generates generalist and specialist competency in care for older people, is long overdue. Nursing must become anti-ageist as a discipline, a stance taken on behalf of this journal by the editorial team some time ago. Our active anti-ageism offers capacity to change attitudes and then reshape professional behaviours. Having established anti-ageism as a foundation for nursing, we can move forward to distinguish the two strands of competency necessary to improve care for older people. The first is generalist competency, something I and many others often characterise as age-friendly nursing or age-friendly health care. The second is the more familiar gerontological specialist competency. Both competencies can imbue generalist and advanced practice roles globally, ensuring that both registered and advanced practice nurses are ready to provide all levels of care and support needed by older people and their families in every setting.

Defining age friendly nursing, along with our anti-ageist stance, requires hard work. Practicing nurses and our educators require education in these two domains as much as our current and future students do. Such education requires new models and frameworks to organise what and how we teach. We might look to the American model of the 4 M's from the national Age-Friendly Health Systems initiative (https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx) or the more international model of the 5 M's of Geriatric Medicine (https://www.healthinaging.org/tools-and-tips/tip-sheet-5ms-geriatrics). We might equally develop a novel nursing model of age friendly nursing or modify current models addressing similar aims of improving care for older people. Regardless of the model we use, age-friendly must characterise all our care. Indeed, our oft-vaunted lifespan perspective anchors the worthy argument that age-friendly must include all ages from birth through death. Why then do we persistently disregard our own values? We must always be prepared and competent to care for the person as their age, identity, social support, health, and well-being warrant. Thus, anti-ageism must make us aware as age-friendly will make us able.

Extant models for improving care for older people do exist, offering a foundation on which we might draw. The Nurses Improving Care for Health Systems Elders (NICHE) (https://nicheprogram.org) model is well established and extends beyond the United States to three other countries. However, with only a few hundred institutions participating worldwide and no preregistration curriculum, the reach of NICHE is insufficient to fully meet our needs. Other, more focal initiatives such as End PJ Paralysis (https://endpjparalysis.org) also hold promise, taking science—in this case on mobility and health—effectively into practice. Even with the improvements that NICHE, End PJ Paralysis, and other programmes around the world are achieving, we need vastly more extensive and fundamental transformation. That transformation must make competent care for older people requisite for all, not optional or voluntary.

We must speak the truth and then act accordingly if we are to educate the nursing workforce we need. Deep down, we know that passively awaiting the time when, for example, delirium assessment and intervention becomes part of our second nature like taking vital signs or when elder speak—the habit of speaking to older people as though they were children—becomes abhorrent to all, simply will not work. We must actively build our anti-ageist stance with the understanding that healthism, ableism, and all other forms of social discrimination are interrelated. Doing so enables us to integrate our age-friendly advancements into the evolving landscape of truly just social and health care. We must couple gerontological nursing education by choice for those who aim to specialise with a new mandate of age-friendly education for all, generating robust age-friendly nursing that matches or even exceeds what we are achieving in gerontological nursing.

Here at IJOPN, our anti-ageist stance informs what we publish. We already advise our authors not to problematize older people and ageing populations. Ageist terms of reference like ‘elderly’ are not accepted. More specifically, we scrutinise manuscripts that report only students' attitudes towards older people and caring for them, urging authors to study interventions and examine implications and actions. With the hope that IJOPN draws many readers and prospective authors who do not identify themselves as gerontological nurses, this editorial represents our next step in contributing to a more just, age-friendly world. We invite authors synthesising evidence in anti-ageism and age-friendly domains relevant to nursing and health care to submit their manuscripts. We encourage nurses and interprofessional teams defining and testing globally relevant age-friendly social and health care education and practices to consider IJOPN as a potential venue for disseminating their research. And we welcome authors designing, implementing, and testing age-friendly models and curricula to think of submitting reports of those innovations to IJOPN.

As always, we embrace opportunities for conversation, particularly through social media. We at IJOPN want to hear from older people, advocates, educators, clinicians, and researchers about their thoughts on anti-ageism, age-friendly nursing, gerontological nursing, and education necessary to achieve all three. You can find us on Twitter at @IntJnlOPN and on Facebook at https://www.facebook.com/IJOPN/. Please use our hashtag #GeroNurses and add the hashtag #AgeFriendly when responding to this editorial. Note that this and all our IJOPN editorials are now free-to-read whether you subscribe to the journal or not. Making our editorials accessible to all readers is a change that we hope helps generate a deeper conversation, and spurring transformation. We look forward to hearing from you.

同事、朋友和家人经常与我分享他们关于医疗保健成功或更常见的错误的故事。他们的故事说明了我们全球需要一支准备好并有能力照顾老年人的护士队伍。那些联系我的人首先用不祥的语气说“让我告诉你发生了什么事，莎拉”。然后他们提出了一些不需要问的简单问题。'这怎么可能发生？“他们怎么能这样对待我？” “为什么这会发生在我（或我爱的人）身上？” 我的回答是对他们困境的微不足道的回应。

We gerontological nurses know well the concerns these stories express and much more. Nascent solutions are at hand but a question we commonly ask ourselves obscures them from view. What question you ask? This one—‘how can we encourage our students to choose careers working with older people?’ Around the world, we talk about encouraging these careers. We study our students' preferences and ultimate choices. Yet we keep returning to the question. This question seems never to fade, despite having been partly answered in various ways, because it belies an insidious half-truth. We hold a misguided conviction that nurses do indeed have a choice about whether to work with older people or not. The stories told to me create a far different narrative.

护士确实可以选择我们与老年人合作的程度。我们可以选择专门为老年人提供护理，我们所有的患者和客户都按年龄排列。做出这种选择的我们是老年护士，这是国际老年人护理杂志 (IJOPN)自成立以来所针对的专业社区。尽管如此，不选择老年护理的护士仍将与老年人一起工作并照顾他们。要做到这一点，他们必须特别胜任，摒弃陈旧的观念，即简单地照顾老年人会产生有效的、基于证据的护理，从而满足接受治疗的人的需求和期望。

当护士根据专业或护理环境选择工作时，大多数需要照顾老年人的职业选择都是默认做出的。一位护士碰巧在疗养院找到了一份工作，并且很喜欢这份工作。另一位护士悄悄地对自己承认“我不想和老年人一起工作”，并在成人外科病房寻找一份工作。两者最终都主要与老年人一起工作，无论是默认情况下，还是违背他们的意愿。最终，事实是护士目前认为他们选择是否与老年人一起工作。然而，他们这样做是在没有足够的知识和理解对老年人有效的循证护理需要什么的情况下这样做的。

所有护理涉及老年人的程度从专业到通才，再到支持性。我们老年科护士是专家。在成人环境中执业的护士，包括大多数慢性病专科、几乎所有成人医院病房、家庭护理和大部分初级护理都是通才。在支持领域工作的护士是那些在母婴和儿科环境中执业的同事，在这些环境中，老年人仅表现为照顾者。在这里，与年长的看护人接触似乎无关紧要，但实际上，往往有助于确保整个家庭的健康和福祉。因此，建议护士可以选择他们可以完全避免与老年人一起工作的专业和环境，同时也是年龄歧视和不真实的。

我们专注于促进老年人护理职业的隐含年龄歧视源于这样一种建议，即避免老年人在某种程度上是可以接受的。老年人是世界上每个家庭和每个社区的一部分。在每个医疗机构中，老年人都是患者、护理人员或两者兼而有之。当我们说“选择与老年人一起工作”时，护理和其他卫生专业一样，无意中赞同了社会普遍存在的矛盾结构性年龄歧视。不，您可以选择专门从事老年护理，但您不能避免与老年人一起工作。

我们目前关于选择与老年人合作的立场表明，只有那些选择老年护理的人需要接受教育以提高他们的相关知识和技能。那些无意中照顾老年人的人之所以这样做，是因为他们所照顾的一些或所有患者在一个宣布专业而不是照顾老年人的环境中按年龄顺序排列。然后期望他们仅通过应用该专业的标准来提供足够的护理。我们通常忽略教育以转变态度和行为，假设那些做出选择的人已经持有必要的态度并表达了适当的行为。同时，我们老年科护士也常常忽视了每个没有选择老年科护理的人与年龄相关的教育需求，留下他们的态度，教他人的行为、知识和技能。结果？医疗保健中持续存在的结构性年龄歧视，成本更高、质量更低，并且对所有人——护士、他们的病人、他们的护理人员和家人都感到不满意。我们需要一种新的方法来确保全球护理人员的需求得到充分满足。

通常，护理，就像我们生活的社会一样，将老龄化人口视为增加工作量的负担并产生只有一些同事选择面对的临床问题。事实上，这个问题并不存在于老年人或老龄化过程中。在我们的教育、我们的卫生系统、我们的职业以及我们的医疗保健同行中的结构性年龄歧视中，老年人的医疗保健体验差、效果不佳以及护理支持不足所代表的问题出现了。问题在于我们。积极消除结构性和个人年龄歧视是所有护士和所有医护人员都必须接受基础教育的起点。

年龄歧视，以其各种形式以及与健康主义、能力歧视和所有形式的社会歧视的相互作用，在世界各地都很普遍。年龄歧视在医疗保健中尤其成问题。许多力量助长了医疗保健领域的年龄歧视。护士和其他医护人员经常遇到极端情况，然后开始感到规范。经常遇到健康状况不佳的老年患者足以促使我们相信所有老年人都面临这种情况。不知不觉中，我们开始看到所有老年人都虚弱、病态，丧失了能力和功能。我们太快地看到老年人过着毫无意义的生活，除了达到他们的实际年龄的美德。不幸的是，护理教育几乎没有改变这种情况。我们的教育促进了我们的同情心，并将照顾发展到了我们太容易剥夺代理权和身份的程度，尽管是出于善意的意图。最后，我们坚持从集体的角度来看，老人只是一个无名的老人，面临着通常的困境。我们变得矛盾的年龄歧视，为老年人做事，而不是和他们一起做。因此，我们一再错过支持他们的人格、理解他们的观点并以他们想要的方式与他们合作的道德和伦理要求。

一种新的护理教育体系，消除年龄歧视，培养老年人护理方面的通才和专家能力，早就该建立了。护理必须成为一门反年龄歧视的学科，这是编辑团队前一段时间代表本刊采取的立场。我们积极的反年龄歧视提供了改变态度然后重塑职业行为的能力。将反年龄歧视作为护理的基础后，我们可以继续区分改善老年人护理所需的两种能力。首先是通才能力，我和许多其他人经常将其描述为适合老年人的护理或适合老年人的医疗保健。第二个是更熟悉的老年学专家能力。这两种能力都可以在全球范围内培养通才和高级实践角色，

定义老年友好型护理以及我们的反老年主义立场需要努力。执业护士和我们的教育工作者需要这两个领域的教育，就像我们现在和未来的学生一样。这样的教育需要新的模式和框架来组织我们教的内容和方式。我们可能会从国家老年友好型卫生系统倡议 (https://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx) 或更国际化的 5 M 老年医学模型 (https://www.healthinaging.org/tools-and-tips/tip-sheet-5ms-geriatrics)。我们同样可以开发一种新的老年友好型护理模式，或者修改当前的模式，以解决改善老年人护理的类似目标。无论我们使用哪种型号，关爱老人必须是我们所有护理的特点。事实上，我们经常吹嘘的寿命观点支持了一个有价值的论点，即年龄友好必须包括从出生到死亡的所有年龄。那么为什么我们总是无视自己的价值观呢？我们必须永远准备好并有能力照顾他们的年龄、身份、社会支持、健康和幸福。因此，反年龄歧视必须让我们意识到，年龄友好将使我们有能力。

确实存在改善老年人护理的现有模型，为我们提供了可以借鉴的基础。改善医疗系统老年人护理的护士 (NICHE) (https://nicheprogram.org) 模式已经确立，并已从美国扩展到其他三个国家。然而，由于全球只有几百家机构参与，而且没有预注册课程，NICHE 的覆盖范围不足以完全满足我们的需求。其他更重要的举措，如 End PJ Paralysis (https://endpjparalysis.org) 也很有希望，将科学——在这种情况下是关于流动性和健康——有效地付诸实践。即使 NICHE、End PJ Paralysis 和世界各地的其他项目正在取得进步，我们仍需要进行更广泛和更根本的转变。

如果我们要教育我们需要的护理人员，我们必须说真话，然后采取相应的行动。在内心深处，我们知道，被动地等待谵妄评估和干预成为我们第二天性的一部分，比如测量生命体征或当老人说话时——像对老人说话的习惯，就像他们是孩子一样——变得令人厌恶。所有，根本行不通。我们必须在认识到健康主义、能力主义和所有其他形式的社会歧视是相互关联的前提下，积极建立我们的反年龄歧视立场。这样做使我们能够将我们对老年人友好的进步融入不断发展的真正公正的社会和医疗保健领域。我们必须选择将老年护理教育结合起来，为那些旨在专门从事面向所有人的老年友好教育的新任务的人，

在IJOPN，我们的反年龄歧视立场决定了我们发布的内容。我们已经建议我们的作者不要将老年人和老龄化人口问题化。不接受诸如“老年人”之类的年龄歧视条款。更具体地说，我们审查仅报告学生对老年人和关心他们的态度的手稿，敦促作者研究干预措施并检查其影响和行动。希望IJOPN这篇社论吸引了许多不认为自己是老年护士的读者和准作者，代表我们为建立一个更加公正、对老年人友好的世界做出贡献的下一步。我们邀请在与护理和医疗保健相关的反年龄歧视和年龄友好领域综合证据的作者提交他们的手稿。我们鼓励护士和跨专业团队定义和测试全球相关的老年友好型社会和医疗保健教育和实践，将IJOPN视为传播其研究的潜在场所。我们欢迎设计、实施和测试适合老年人的模型和课程的作者考虑向IJOPN提交这些创新的报告。

与往常一样，我们拥抱对话的机会，尤其是通过社交媒体。我们IJOPN希望听到老年人、倡导者、教育工作者、临床医生和研究人员关于他们对反年龄歧视、关爱老人护理、老年护理以及实现这三者所必需的教育的看法。您可以在 Twitter 上的 @IntJnlOPN 和 Facebook 上的 https://www.facebook.com/IJOPN/ 上找到我们。请在回复这篇社论时使用我们的标签#GeroNurses 并添加标签#AgeFriendly。请注意，无论您是否订阅该期刊，本文和我们所有的IJOPN社论现在都可以免费阅读。让所有读者都能阅读我们的社论是一项改变，我们希望这有助于产生更深入的对话，并促进转型。我们期待您的回音。