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'Care home nurses should be applauded for their knowledge and skills'


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.

grainne wokes

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


Readers' comments (4)

  • Fully agree with Grainne. Great article. Being exposed to care home work for the first time makes you realise how isolated you can be. There is not always a pharmacy down the corridor or a doctor on-call. Nurses in care homes have to adapt quickly

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  • Absolutely agree. Proud to have run nursing homes for 10 years and set standards to enable me to be a placement for "Return to practice", "Overseas nurses course" "Undergraduate nurses" and used as an exemplar for other homes. Have pride in your knowledge and skills, nursing home nurses need to be far more knowledgeable than say nurses on a specialist Ward in hospital, we need to be able to cover medical, surgical, dematalogical, end of life, counselling, psychiatry and education - stand proud!!

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  • I run a company called No Force First based in Gateshead, Tyne and Wear, and wonder if my experience could help your staff gain further confidence and competence whilst dealing with challenging behaviour..

    I have recently been involved in training staff at Qualia care nursing homes in Washington and Blackpool for challenging behaviour, on how to utilise least restrictive practice to deescalate, breakaway, move a person safely or hold a person safely whilst assisting with personal care.

    I am a registered mental health nurse with experience in psychiatric intensive care units(PICU), forensic services and old age challenging behaviour services, and have been teaching Prevention and Management of Violence and Aggression (PMVA) to staff for nearly ten years.

    No Force First teach a variety of best practice deescalation courses for both nhs and private company/agency staff.

    All of our qualified staff and training is centred around the General Services Association (GSA) techniques, overseen by the British Institute for Learning Disabilities (BILD).

    These courses offer a range of techniques for either deescalating a potentially challenging individual, utilising verbal and non - verbal communication, through to breakaway techniques from either a confused or potentially threatening person, utilising a graded approach. We also have a variety of presentations which include lone workers and discuss the legal aspects of reasonable force.

    Breakaway courses can be adapted to be delivered over either a half day or full day course, as required by the company. . All of our courses require a yearly update. Separate courses are also available teaching Basic Life Support and also how to assist a choking person. All courses can be adapted to suit your companies needs.


    Martin Watson RNMH PMVA Trainer

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  • Thank you Graine what a lovely article.So respectful of the day to day challenges we all face.We are a stand alone force of nurse led environments,sadly depleting due to the lack of funding and subsequent closures.
    Thank goodness for the teams of carers who do the majority of care giving as we as nurses are sadly bogged down with the never ending paper mountain that has become nursing. It is nice when we are on the floor getting on with the job we all trained hard for.Getting away from hoarders paradise and the paper festooned offices!
    Never let it be said we are "JUST" nurses we are a team that should be commended....Pat on the back all round.
    Let's hope that when we are in need of this service that there continue to be teams going above and beyond and giving 100%!

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