I think a lot of nursing students, as well as nurses in general, carry misconceptions about what it’s like to be a nurse in a nursing home. Many don’t really understand exactly what do nursing home nurses do. This guest post will walk you through a typical shift and see if it’s what you imagined.
Every year, our nursing home welcomes nursing students from nearby universities for clinical rotations. When the students meet with the Director of Nursing during orientation on the first day, she always asks how many of them are considering a career as a nursing home nurse.
It’s rare that anyone raises their hand.
A few weeks later, the students again meet with the DON to review their experiences. Again, she asks who is thinking about the nursing home as a career option. This time, it’s typical that several students have decided they might enjoy working as a nursing home nurse.
What Do Nursing Home Nurses Do?
Beginning Our Day
Depending on the nursing home, you’ll most likely work either an 8 or a 12-hour shift. You’ll begin your shift by receiving the report from the outgoing nurse.
Since you’ll be responsible for a large number of residents, nurses can’t go into great detail about each resident during a shift-to-shift report like they do in a hospital. In fact, it’s not unusual for a nurse to be responsible for 30 or more residents in the course of a day shift and even more during the night.
These topics are typically covered during report:
- Residents with recent condition changes
- New orders
- Last PRN (as needed) meds given & response
- Significant abnormal lab results
- Appointments scheduled for today
- Resident or family concerns
- Incidents such as falls
Some nursing homes employ TMA’s (Trained Medication Aides) to pass medications. These are CNA’s with specialized training in medication administration. If you don’t have a TMA during your shift, you’ll hit the floor running to get your medications administered on time. If you’re fortunate enough to have a TMA, this frees you up to focus on other important tasks.
Our Primary Responsibilities
Your shift might include (in no particular order):
- Medication administration
- Blood sugar checks
- Treatments (dressing changes, nebulizer treatments, etc.)
- Rounds with medical providers
- Receiving and following through on new orders
- Care conferences
- Completing assessments for MDS’s (more about that later)
- Updating families
- CNA evaluations
- Checking O2 sats and monitoring O2 administration
- Team meetings & staff meetings
- Assisting residents with meals
- Care planning
- Obtaining specimens (urine, wound cultures, blood draws)
- Consultations with other team members (dietary, rehab, social services)
- Ongoing communication with CNA’s throughout the shift
- Checking & monitoring vital signs
- Skin assessments
- Handling staffing issues such as call-ins
- Pain management
- Lots of documentation
- Answering call lights
- Assisting residents with personal cares such as toileting
- Mentoring nursing students
- Resident & family education
- Consultations with hospice providers
Best of all, during those precious shifts when you have a bit of extra time, you can enjoy interacting with your residents. This might mean simply visiting, joining them in an activity for a few minutes, or doing something special to pamper a resident. That’s the best part of being a nursing home nurse!
What Happens During A Shift:
Oftentimes, a medical secretary is on staff during the day shift. This is enormously helpful, as they can transcribe orders, make appointments, and field phone calls. If you don’t have a medical secretary, you’ll need to take care of these tasks yourself. As a staff nurse, you’ll supervise several numerous CNA’s. While, of course, you need to get your own work done, it’s also wise to help out the CNA’s whenever possible. You’ll earn their respect and promote a more positive, team-like atmosphere.
Physicians, nurse practitioners, and physician assistants make regular rounds at the nursing home. Not only do they see residents according to schedules mandated by Medicare and other agencies, but they also see residents for concerns that come up from day to day. As a nurse, you’ll need to be up-to-date on the resident’s condition so you can offer information and answer questions. You’ll also make rounds with a variety of other medical professionals that could include psychiatrists, podiatrists, and wound care specialists.
Many nursing homes now employ admission nurses who oversee a new resident’s transition to the nursing home. However, as a staff nurse, you’ll help with this process as needed. In conjunction with the nursing home social worker, you’ll also help assure a smooth transition when a resident is discharged. This includes discharge education, as well as assuring that all follow-up services, medications, and equipment are arranged.
Staff nurses must be flexible and able to multi-task. Frequent interruptions are par for the course. This means responding to requests from residents, phone calls from family members, questions from CNAs, return calls from medical providers and dropping what you’re doing to assess a resident with a sudden change in condition.
Excellent assessment skills are crucial in a nursing home. Since you don’t have a lot of time to spend with each resident, you need to constantly watch for subtle changes. And when a resident develops an acute condition, you need to be able to quickly assess the situation, provide thorough information to the physician by phone, communicate with families, support the resident, and delegate tasks to other staff members—all while keeping your cool.
Interestingly, in many nursing homes, there aren’t a lot of differences between the role of an RN or an LPN. While some roles (MDS coordinator, unit coordinator, etc.) require the nurse to be an RN, the role of the staff nurse is often the same regardless of education level.
When people ask, “Don’t you get bored at night when all the residents are sleeping?”
Documentation And More Documentation
Nursing home nurses are increasingly being asked to do more documentation in order to comply with state and federal regulations. A huge part of this documentation is something called the MDS.
The Minimum Data Set (MDS) is an extensive clinical assessment required for all residents in Medicare or Medicaid certified nursing homes. While most nursing homes employ a specially trained RN to oversee this process, documentation is required to support all of the information that is entered into the MDS. Therefore, staff nurses are responsible for providing assessments and progress notes to back up the MDS.
The accuracy of an MDS is crucial. It determines how much a resident pays for care at the nursing home drives the resident’s care planning process and is used to help determine if a facility is in compliance with state and federal regulations during a survey (inspection).
What’s Great About Being A Nursing Home Nurse
People often tell nursing students that it’s a good idea to get experience on a general medical-surgical floor of a hospital after graduation. In my opinion, a nursing home is also a terrific place to start out as a new nurse. You’ll have an opportunity to hone your basic nursing skills, as well as develop supervisory experience.
A nursing home is also a great place to establish a career. I love the fact that in a nursing home you get to know residents and families on a long-term basis. At a hospital, a nurse often has a short, intense caregiving relationship with a patient, and then they quickly move on to another unit or perhaps go home. You never get to learn the end of the story. In a nursing home, you have the privilege of working with residents for weeks, months, or sometimes many years.
One of the things I enjoy about geriatric nursing is the fact that you work with such a wide variety of residents with a wide array of diagnoses. As a result, you’re able to keep up your knowledge and skills in many different areas. These include:
- palliative care
- mental health
- developmental disabilities
Years ago, most nursing homes provided custodial care. However, at today’s nursing home we find more residents coming in for short-term rehab and then returning home. We also provide care for residents with more complex needs such as:
- Peritoneal Dialysis
- Wound Vacs
- Tube Feedings
- PICC lines
There are a lot of exciting changes coming down the pike in nursing homes these days. Rather than working under the traditional medical model, nursing homes are becoming more home-like and focussing on person-centered care. We also see more nursing homes employing universal workers. These specially trained CNA’s fill multiple roles (direct care, activities, housekeeping, dietary,etc.) in order to best meet the needs of the residents.
What’s Challenging About Being A Nursing Home Nurse
One of the most difficult aspects of working as a nursing home nurse is the negative perception much of our society has about nursing homes. Because of bad things that have happened at some nursing homes, the public tends to think that nursing homes are places to be avoided and mistrusted.
What they don’t see are the highly skilled, compassionate, and dedicated nurses and other caregivers who work very hard to provide the best possible quality of life for our residents.
Fortunately, this perception is improving over time and people who work in nursing homes are receiving more respect and recognition.
Of course, nursing home nurses face many of the same challenges as nurses in other types of healthcare: staffing shortages, rotating shifts, physically and emotionally demanding assignments, and hard-to-please physicians, families, and co-workers.
But, at the end of every single shift, we get to go home knowing that somebody’s day was made better because we were there. Now, what could be greater than that?
Diane Lansing, BAN, RN has been a nurse for over 35 years. She currently volunteers at the nursing home where she previously worked as a nurse manager. Her special area of interest is Alzheimer’s disease and other forms of dementia. Diane blogs about her nursing home adventures at Nursing Home Volunteer.
Fast Facts for the Long-Term Care Nurse: What Nursing Home and Assisted Living Nurses Need to Know in a NutshellEvidence-Based Geriatric Nursing Protocols for Best Practice, Fifth EditionNobody’s Home: Candid Reflections of a Nursing Home Aide