Guest Post: What Is It Like to Work in a Nursing Home?

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What is it like to work in a nursing home?

Chris Urbano is a registered nurse with 12 years of experience working in an upstate New York residential health care facility. She has worked in a variety of nursing specialties from hospital staff nursing to school nursing. She is also a contributor to’s careers in nursing and career planning guides.

What image comes to mind when you think of a nursing home? The vast majority of people probably picture a rather depressing scene. You may think of old people who are tied down or force fed with a syringe. You may associate unpleasant smells, like those of urine and feces, with nursing homes. While perhaps these stereotypes were once true in some nursing facilities, over time regulations and advocacy groups have greatly improved the care that is provided. Now, the focus is on resident rights and providing dignity and choice. And along with improvements in living standards for residents, it has become a rewarding place for nurses to work as well.

(Note: Within the industry, the term nursing home has fallen by the wayside. The names of most facilities now end in “Residential Health Care,” “Life Center,” or, more simply, “Home.” The industry is called Long Term Care, or LTC, which is a more accurate description of the services provided.)

I actually entered the LTC field by accident, when the hospital I was working for asked me to help out for a short time at a long term care facility with which it is affiliated. Now it’s a dozen years later, and I am still at the same facility! I truly found my passion and plan to work within this nursing specialty until I’m ready to retire. And now I’ll tell you why.

Working here allows me to be a key member of a true interdisciplinary team, a team that consists of a physical therapists, social workers, unit managers, dieticians, activity directors, and the director of nursing. The entire team meets daily to discuss any relevant issues in the past 24 hours, or over the weekend. As we review the residents on report, the team discusses the plan of care and we all discuss any changes that can improve the quality of care we give. In addition, residents and their families are considered an integral part of the team and the care plan. This is much different than a hospital where a similar set of team members exist, but tend to work independently.

Then there are the residents we serve. For the most part, they are amazing and give me far more than I give them. One of the nice things about long term care is that you get to know your residents’ life stories and you develop real friendships. By getting to know both the medical and non-medical aspects of each resident, you are able to create a care plan that is individualized and unique. For example, when you find out that a new resident was a farmer her entire life, you plan for her to get up very early each day. Information like this is very important, especially with the Alzheimer’s population. We once had a resident who had been in a concentration camp and became very agitated during fire drills, so we developed a care plan that was unique to his situation.

In addition to understanding a resident’s life story, you also need to monitor and assess physical changes. These skills are particularly important in this nursing specialty because there is not always a doctor available. Developing and exercising these assessment skills are a satisfying and stimulating element of the work.

The challenges involved in long term care nursing are unique to the individuals and their families, and they tend to vary greatly from day to day and resident to resident. One of the hardest challenges is decision making in terms of prolonging life. Many residents have health care proxies, but are not always clear about their choices, leaving families feeling lost. Then there are residents who have made clear decisions, and their families don’t follow them. As a nurse, you need to be able to leave your opinions aside and try to educate the families. I had one case in which a son was not following his mother’s wishes when she could not longer make decisions for herself. He was having a terrible time letting go and it took a few months of supportive listening and educating for him to come around.

In this setting, I really feel like I make a difference for my residents and their families. I would highly recommend LTC for nurses who are looking for very rewarding and challenging work and the chance to get to know some wonderful people who have led interesting lives. In this field, you touch many lives, and others certainly touch yours as well.

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