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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)

  • I'm an NHS clinical oxygen specialist nurse who reviews patients on the wards, in clinics but the majority are in the community. I have had patients who have really struggled at home and unfortunately I have had to encourage them to go into care homes but they have flourished and lived much longer with better quality of life than if the had remained at home.
    I think sometimes NHS ward nurses think that care home nurses are trying to be difficult or lazy when actually they are asking very important questions. Care home nurses ask questions to ensure that the resident is well enough to return to them with a clear plan of care/ follow up because they need to be able care for that resident while having many other residents to care for with minimal support from outside service.
    Unfortunately as on NHS wards there is the odd nurse in care home who's communication, knowledge or attitude is poor and sadly people remember that and not all the good things you guys do !!!

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  • As a nurse who works nights in a care home I have to deal with whatever crops up as I am in charge and have sole responsibility for whatever happens whether that is a medical emergency or other emergency. I have dealt with a flood in the building, a 6 hour power cut which meant there were no working fire alarms, lift etc, and police searching every single room in the home looking for possible intruders. I have to stay calm in whatever circumstances. I don't have medical back up, security or other people to help me as they do in hospitals. It can be a stressful job!!

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  • Well said Mary! Care home nurses are an essential ( and all too often underestimated) part of our complex health and care system.
    As part of my hydration project work I have worked very closely with care homes and each time I am struck with the level of responsibility and clinical decision making that care home nurses have, all too often in total isolation.

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  • Mary,

    You missed something here:
    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.
    And that is: You are absolutely amazing!

    Love
    PDave Angel

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  • Well said Mary. You sound like a fabulous nurse. So positive . You make a very valid point regarding working in isolation and having to make clinical decisions on your own.
    Part of my role is to support care home and nursing home staff . I work in an innovative team, we are the 'Digital Health Centre' part of Tameside & Glossop Integrated NHS Trust. We give advice over Skype to carers, nurses and residents of care homes and nursing homes . Giving clinical advice and clinically assessing .
    Keep up the good work Mary. You are fab ☺

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  • I wonder if the status quo will ever change, we need more qudos for sure!!! For example, the RCN bulletin articles always refers to the NHS, never care homes. It’s a shame! We are so slilled and experienced!!! Thank you for writing the article, much needed. N

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