As a registered nursing home manager of 10 years and a registered nurse of 17 years, I have read many things about nurses and clinical care in nursing homes.
We see the bad press every day, but there is a lack of recognition of the essential role of the nurse in nursing homes and the amazing work that takes place in many homes across the UK.
A nursing home is a truly nurse-led service. We do not have medical staff on site and nurses have to carry out independent clinical assessments continuously.
Like all nurses they monitor vital signs for any changes. Acute illnesses often have atypical presentations in older people and residents with complex medical conditions, so they also have to be alert to the slightest changes their residents patterns of behaviour.
“Nursing home nurses need to have a wide knowledge and skills base”
Nursing home nurses need to have a wide knowledge and skills base. They need to be able to carry out phlebotomy, catheterisation, wound care, and administer complex medication regimes.
They also need to be able to meet the needs of people with learning disabilities, mental health problems and complex clinical conditions such as Huntington’s disease and multiple sclerosis.
These nurses manage PEG feeds and syringe pumps. They are expected to maintain hydration levels and nutritional intake in the most frail of residents without intravenous infusions or the support of an on-site dietician.
They have to know food preferences of those in their care and find out how best to encourage residents to take just “one more mouthful”.
Nursing home nurses have a vital role in end-of-life care. They sit with residents and discuss end-of-life plans, put those plans in place and then hold the hands of their residents as they slip away. Sometimes they will have nursed these residents for years. The moments no one else sees are the tears that come afterwards or the nurses standing by the graveside saying their final goodbye.
“They need to evidence conversations, assessments, care plans and test results”
In a nursing home these nurses don’t just look after the residents but also their wives, husbands, children or parents. They get to know the occasions that are special to them – the birthdays and the anniversaries, the highs and the lows.
When all this is done, these nurses need to document it all. They need to evidence conversations, assessments, care plans and test results.
This is but a snapshot of a day. This does not include the continuous call bells and phone calls – day and night. Like all nurses, nursing home nurses provide supervision for junior staff and support for each other. The difference is they are forgotten about.
I’ve heard multidisciplinary team members use dismissive phrases such as “She is only a care home nurse”. Yet, care home nurses deserve to be applauded for their wide range of knowledge and skills across a range of disciplines.
Gráinne Wokes, manager at MHA Hillside Nursing Home in Buckinghamshire