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'I'm just a care home nurse'

  • 26 Comments

I chose this title as that’s how people see me: ‘just a care home nurse’. But I know that I and my sector colleagues are so much more.

mary rabbitte

mary rabbitte

Mary Rabbitte

I’ve worked in the NHS for years and, like many others, I choose to work in social care. I didn’t end up here as a last resort or as a desperate attempt to pay the bills. That’s the first of many myths of how others see me. 

The truth is, registered nurses working in care homes have to be better than the rest. They need to be well-rounded, skilled, knowledgeable and effective. These skills are imperative to deliver good care. Why? Because most of the time you’re on your own. In no other sector have I had to make so many decisions - complex decisions - with just one chance to get it right.

“In no other sector have I had to make so many decisions”

The multiple comorbidities people live with are often overlaid with poor communication skills as so many of those in our care are living with dementia. Things change on a daily basis, such as a person’s responses, but when someone starts to deteriorate rapidly, the skills that come from years of practice of recognising subtle changes in an individual’s behaviour, response or demeanour come to the forefront.

The ability to assess those changes and take action is what makes care home nursing so skilled. The longevity in the relationship with residents and investment in building a relationship over time gives us a unique relationship with our patients. The continuity in our care enhances our observation and assessment skills in a very unique way. It means we see the most subtle changes and can act fast to ensure appropriate and timely intervention. The tipping point and admission to hospital can often be avoided through proactive management of ‘crisis’.

“We see the most subtle changes and can act fast”

Often there isn’t a colleague to consider a dilemma with, or a peer group to turn to, or a rapid medical response, or immediate access to a doctor to consult. Care home nurses have to be ‘on their toes’ to ensure those in their care get the best.

You can’t just be a care home nurse overnight. It is not a job that just anyone can do, you have to have a broad experience to fall back on. You are at the front line when things go wrong so you need experience of multiple condition management, strong clinical decision making ability and assurance and confidence in your practice. Your understanding of accountability and governance is paramount to underpin practice in this field. 

Care home nursing is so misunderstood and we are in part to blame for not teaching others about what we do, who we are, the difference we make and the challenges we face. I wouldn’t go back to the NHS now. I’m far too skilled and I really believe I would be frustrated not being able to practice with the greatest freedom and autonomy. 

“This is a speciality where nursing is nursing and there’s lots of good practice to share”

If we don’t challenge others about their ignorance of our speciality, we only have ourselves to blame and only ourselves to be frustrated with. This is a speciality where nursing is nursing and there’s lots of good practice to share.

So, I’m not ‘just a care home nurse’: I am an intuitive, skilled, insightful nurse. I am skilled, I have longevity in my relationships and knowledge and insight into the needs of those in my care.

Mary Rabbitte, unit care manager, Jewish Care

  • 26 Comments

Readers' comments (26)

  • Karen Powell

    Well said. I recently returned to nursing and work in a care home for dementia care and brain injuries. We often get looked down upon by our NHS colleagues

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  • Heads up to all our social care workforce - often working alone, often forgotten but quietly building relationships vulnerable people and changing lives.

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  • Well said, it is about time highly skilled care home nurses stood up to the stigma of being judged as second best. We do have to make solo decisions on a daily basis and our care is outstanding in all areas of our nursing experiences. Working in the care sector myself, i know how difficult it can be to prove our skills on a daily basis to other healthcare professionals and we probably do need to promote our skills more to encourage new generations of nurses to want to work in our field with pride and satisfaction.

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  • Wow! Well said. I work as a unit lead in a nursing home and everything you said was spot on .

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  • Well said couldn't agree more!!

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  • Well said! i just smile now when I see the way my nhs colleagues look down on me- I know what I do and I know I make a difference to those I am responsible for and for their families who are able to relax and get on with their lives knowing their loved ones are safe and well cared for. I work as a care home manager and love the fact residents drop into my office - who live with dementia- for a chat- this is unlikely to happen on a nhs ward. I love how we can deliver real person centred care, be innovative with our practice and lead and develop teams of staff to do the same. We know there can be bad practice out there but that's the same for the NHS too. And likewise there is very good practice in the care homes- maybe we should showcase more of this.

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  • How right you are Mary. I have works in the independent care home sector for almost 30 years and am passionate about delivering the best quality are and service st all times. Sadly, the sector gets a bad name from the minority of care home owners who put profit before quality. Sadly, mud sticks. Passionate care home staff should be proud and shout loudly about what they do. As you say, they are intuitive and highly skilled staff. Long may it continue!

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  • I work with RNs in Australia and Hospital nurses who are used to working with protocols and care pathways are quite lost when they are in a home care setting and need to make complex decisions without access to other senior staff , or other health professionals at a moments notice. Totally agree with the writer that the autonomy the role brings is using critical thinking at it best. have a look at www.criticalthinkingcare.com.au the 2nd scenerio is on aged care.

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  • I think this accurately describes how I feel about my job

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  • Absolutely agree - I am clinical lead at a large care home and have years of experience of NHS acute and community care leadership and practice. You really do need to know your onions in this field, be assertive, competent, a good teacher and communicator, build relationships very quickly and be caring compassionate and resilient. Salary is rubbish compared to jobs I have done with far less responsibility, but this is less important to me than the feeling of being valued, part of a close knit team, challenged and supported to give my personal best for my team and our residents. I would not change my job for the world, but don't underestimate those of us who choose to work in this environment. There is nothing easier, less taxing, less knowledgeable, less skilled about being a nurse in a care home. We don't want anyone here who doesn't want to be the very best nurse they can be, every shift!

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