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Nursing in Nursing Homes: Exploding the Myths

January 13, 2015

A guest blog by Claire Phillips @clarahopscotch

Working in a nursing home is seen as a job you do when you can’t get a job in a hospital or maybe when you’re close to retirement and want an ‘easier life’. I remember clearly the ‘dirty nursing home’ comments from nursing staff when I was a student. Stories like this don’t help the cause either.

I am currently working in a medium sized nursing home that operates over three units dealing with elderly care, learning disabilities, acquired brain injuries and those with complex care needs. I’ve worked there since qualifying – nearly two years now. I remember spending the first few weeks convinced I’d made some horrible mistake (being a nurse, not working in a nursing home!) but now I wouldn’t want to work anywhere else.

During my training, I’d had doubts that I was a ward nurse. I am rubbish with names. I would just about remember a patient’s name when it was time for them to be discharged. My favourite placement was my management placement on an acute stroke/elderly care ward where I got to spend a substantial amount of time and patients were often there for weeks rather than days. It was here I realised long term care was where I wanted to work.

One of the misconceptions about nursing homes is that as a nurse, you don’t acquire the same range of clinical skills. It depends on where you work of course, but I deal with catheters, tracheotomies, PEG feeds and wound dressings on a daily basis. I have residents who can deteriorate rapidly and I have to communicate effectively with GP surgeries and Out-Of-Hours services to make sure I get appropriate treatment for them. You’ve also got to use your initiative. Every box of medication, every catheter and piece of equipment is usually individually prescribed for each resident. If a feeding pump breaks in the middle of the night or a catheter needs to be replaced twice in as many days and you don’t have a spare, then you have to sort it. For this reason I have two pairs of Spencer Wells forceps in my bag so I can undo overtightened PEG giving sets without the need to replace the whole feeding tube!

Like every nurse, I have to manage my time effectively. On a twelve hour shift, I can spend five hours doing medications, which leaves seven hours for dressings, calls to GPs, liaising with other health care professionals (HCPs), evaluations, updating care plans and risk assessments. I have to manage my staff by – depending on their skills – allocating them to work either on the floor or with a resident who requires one-to-one care. Occasionally I have to deal with conflicts amongst staff and between residents. I frequently have to take phone calls from staff phoning in sick.

And while we’re on the subject of skills, some of the skills you have to obtain are not directly linked to nursing. I’ve completed fire warden training and have had to manually lower a broken lift to free two trapped persons (and a goldfish).

The staffing crisis that is well documented in the NHS also extends to nursing homes which have sometimes faced closure because of a lack of qualified staff. This puts existing staff under increased pressure to work extra shifts and means Continuing Professional Development is done in your own time. This is an issue that affects nurses nationally and until we have the right amount of nurses working across the NHS and private sector, it is unlikely to improve and both sectors need to work together to make sure staff are keeping up to date. After all, a lack of suitable accommodation for those needing long term care delays discharges and puts pressure on the acute sector.

You need to communicate effectively and build good relationships with families and other agencies who are involved in the care of your residents. This can be challenging when it is obvious that the HCP/relative you are dealing with has the same preconceptions about those who work in a nursing home as I am detailing in this blog piece. It doesn’t happen every day but it happens more often than you would like to think. From a professional standpoint, how is this sort of tribalism in the best interests of the residents? When it is the resident’s family that have this opinion, then you have to work hard so they trust you. It’s very fulfilling when they finally do.

Healthcare assistants tend to come and go with alarming frequency within many healthcare environments. For some, they will never have worked in care before and will swiftly realise it is not for them. For others the low pay, unsociable hours and – dare I say it – hard work will prove the reason why they don’t return. It seems almost unbelievable that we are paying people minimum wage to provide the most intimate care to people who need it.

It’s a challenge to make sure these staff stay engaged. Keeping morale up when you’re short staffed on a Sunday morning is difficult but not impossible. Registered nurses are key to developing carers. Where I work we try to do daily teaching sessions on a variety of subjects from mental capacity to infection control. For those who aspire to become nurses themselves, good nursing homes offer an excellent grounding in healthcare and help them develop many of the essential skills they will need as a registered member of staff.

Being a nurse in a nursing home can be every bit as busy/frustrating/rewarding as working in any other healthcare environment. I like going to work and seeing the same residents every shift. It suits my skills as a nurse and my personality. I’m definitely never bored and I feel I have so much still to learn. It is not for everyone but nursing is diverse and that’s what makes it such a brilliant career for so many people. But in assuming nursing home staff are stupid or incompetent, we do the profession a disservice. And by actively discouraging nurses from considering nursing homes as a valid career option, are we by extension saying that nursing home residents don’t need or deserve the best staff?

  1. Excellent blog! I’ve been a nurse practitioner in skilled nursing facilities for 13 years. Always interesting with a medically complex and chronically ill patient population who are our honored elders. I’ve gained experience in rehabilitation nursing, wound care, palliative and end of life care, and chronic disease management. So glad my undergrad nursing experience brought me to a LTC facility because I had no idea that I would love it so much when I started school thinking I wanted to be a PCP in an office. When I saw my classmates disregard working with older people, I was perplexed, because I found it so fulfilling to serve one of our most vulnerable patient populations. Nursing is an excellent career path because there are so many choices, and LTC is a great one!

  2. Reblogged this on Nursing The Words and commented:
    Something I wrote last year about the challenges of working in a nursing home.

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