The Unseen Challenges and Rich Fulfillments of Elderly Care Nursing in a Nursing Home
After over two decades as a registered nurse, I've had the privilege of working in various capacities, from hospital settings to skilled nursing units, home care nursing, and long-term care facilities. One role that stands out in its complexity and impact is that of an elderly care nurse in a nursing home. Let's delve into the lesser-known aspects of this job and the everyday realities.
The Daily Documentation and Assessments
One of the most critical tasks in elderly care nursing is the extensive documentation and assessments required. As a nursing home nurse, every fall - whether observed or not - demands a meticulous assessment. For falls that involve head trauma or are unobserved by staff, nurses are required to take multiple sets of vital signs in intervals of 15, 30, and 60 minutes, followed by four-hourly checks for the next 72 hours. This rigorous monitoring ensures that any potential injuries are identified and addressed promptly.
Further assessments include a neurological evaluation, which involves checking the patient's orientation to person, place, time, and event; the ability to focus with their eyes; and ensuring strength is equal on both sides. Post-assessment, the nurse must fill out an injury report, notify the attending physician, and the patient's family. If hospital visits are necessary, detailed documentation must be submitted to ensure proper care.
Continuous vigilance is also required for any other form of injury, such as scratches, bug bites, bruises, or skin rashes. Even a cough during or after drinking, or complaints of stomach pain or burning with urination, necessitate a thorough assessment. The size of these injuries must be accurately measured, and reports must be filled out and communicated to the doctor and family. We also keep a close eye on the patient's progress and the effectiveness of the treatments.
Meeting Medical Orders and Managing Medications
Maintaining precise records and ensuring that all medical orders are correctly entered into the patient's chart is a daily responsibility. We manage appointments and provide the necessary documentation to ensure the patient receives timely medical attention. Depending on the patient's needs, we conduct detailed daily assessments that may span multiple pages, and for long-term patients, we perform monthly assessments.
We are also responsible for dispensing prescribed medications as per the schedule, and administering treatments as required. In addition, we oversee Certified Nursing Assistants (CNAs) and ensure all care and documentation are completed each shift. Daily chores, such as cleaning, ensure the overall well-being of the patients. These tasks often need to be performed with fewer staff members, sometimes as few as one nurse for an entire building, making our role even more demanding.
Third Shift Challenges and Teamwork
As a third-shift nurse, these responsibilities are compounded by the added challenge of working with a skeleton crew. On any given night, a single nurse might manage anywhere from 20 to 60 patients, depending on their acuity and the overall staffing situation. I have personally experienced situations where a single nurse and possibly one CNA would care for the entire facility. In contrast, I have also worked in environments where each unit is assigned a specific nurse and in some places, a single nurse might be responsible for multiple units at night. In all cases, we rely heavily on team support and cooperation to answer call lights, assist with patient turns, and provide necessary care.
When I was working in a hospital setting, I was typically responsible for no more than 7 patients. The stark contrast between the hospital and the nursing home environments highlights the unique demands and skills required for elderly care nursing.
Conclusion
The role of an elderly care nurse in a nursing home is a multifaceted and demanding one. It requires a deep sense of empathy, accuracy in documentation, and the ability to maintain high standards of care even with limited resources. Despite the challenges, the profound impact we have on the lives of our patients and their families makes these experiences incredibly fulfilling.