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A skilled nursing facility, long-term care facility or nursing home provides for patients who require care 24/7. Patients at a facility like this may include elderly patients, patients recovering from illness or traumatic injury, and patients with chronic or degenerative conditions. CNAs and LPNs provide much of the day to day care in these settings, the RN plays a crucial role in overseeing treatment and making sure that all patients receive the highest standard of care.

In this type of facility some of the patients may not recover enough to live on their own, unlike a hospital setting where patients return home after they recuperate. Many facilities specialize in geriatrics which means caring for seniors with Alzheimer’s disease, dementia and other conditions that require constant observation and monitoring. There are also facilities that treat patients with traumatic brain injuries or degenerative diseases that have left them permanently impaired. The Registered Nurse in a facility like this will focus on improving the patients quality of life and helping keep chronic conditions under control.

CNAs and LPNs can perform only limited tasks and the RN will perform most of the invasive or complex treatments. The RN may draw blood, administer medications and injections and prepare and insert IV lines. Monitoring each patients health and progress through careful evaluation of each patient, their vital signs and assessing other indications of physical and mental well-being. The RN will also determine the treatment plan for each patient and ensure that the care strategy addresses the long-term needs of the aging process and the conditions the patient is coping with.

A Skilled Nursing Facility must have at least one RN present each day for 8 hours by federal law. Many of these facilities only have one RN on duty at a time and the RN is often the supervisor of the CNAs, LPNs and direct care support staff. The RN must ensure that the patients receive continuous care during shift changes. The RN usually has more experience and training than the other workers in the facility and might be the Head Nurse or Director of Nursing. As the supervisor it is the duty of the RN to delegate tasks, assign employees to specific patients and to monitor the overall quality of care all the patients in the facility are receiving.

Registered Nurses at the Skilled Nursing Facility provide direct bedside care and act as patient advocate and educator. The RN will educate the patient and family members what to expect when dealing with the challenges of aging or specific conditions the patient may have and help them understand what contributions to recovery and long-term wellness they can make. The RN will also inform family members of any changes in the patient’s condition and discuss with them any alterations to the patient’s medication or other treatments. Collaborating with the facility physician to help create and implement patient care plans and notifying the physician if there is a change in the patient’s condition.

Some functions of Skilled Nursing Facility Registered Nurses

  • Ensuring all work areas and residents rooms are maintained in accordance with safety and sanitation standards.
  • Ordering medications, equipment and supplies as prescribed.
  • Preparing and administering medications ordered by the physician in accordance with policies and procedures.
  • Attending rounds with physicians, nurse practitioners and physicians assistants.
  • Assisting with the orientation of new staff to the unit.
  • Collaborating with the residents physician to provide the care, services, treatments and rehabilitation ordered.
  • Communication with the residents physician and/or family members when there is a change in residents condition or if any incident occurs involving patient.
  • Administering professional nursing practice services such as: tube feedings, suction, catheterization, changing of dressings, packs and irrigations as necessary.
  • Gathering samples of sputum, urine and other specimens for lab tests as ordered.
  • Continuous observation and monitoring of seriously ill residents.
  • Being the patient advocate and ensuring that other health care team members are providing care according to the residents care plan and personal wishes.
  • Receiving, transcribing and implementing physicians orders according to facility procedures.
  • Accurately completing necessary charting as required and in a timely manner following established charting policies and procedures.

Qualifications of the Skilled Nursing Facility RN

  • Communications skills, read, write, speak and understand the English language.
  • Possesses the ability to make decisions independently when such action is warranted.
  • Ability to communicate on a personal level with residents, family members, personnel, visitors, government agencies and the general public.
  • Work well with others and show leadership and supervisory ability.
  • Knowledge of medical and nursing practices and procedures, and the regulations, laws and guidelines pertaining to long term care.
  • Maintain a cheerful, patient and enthusiastic disposition and handle difficult residents.
  • Display a willingness to research and learn about new methods and principles and ways to incorporate them into existing practices to benefit the resident.

Demonstrate Safe and Effective Use of Equipment such as:

  • CPM
  • Oxygen wall regulators/portable oxygen
  • Patient Call System
  • Electronic thermometer
  • TPN administration
  • Foley catheters
  • Geri chair
  • Specialty beds
  • Computer, printer, copier, fax
  • NG tube/suctioning
  • Drains
  • Safety bed alarm system
  • IV pump
  • Gait belt
  • Dinamap
  • PCA
  • Crash Cart
  • Defibrillator
  • Insulin pump
  • Lifting equipment
  • Enteral feeding pump
  • Anti embolic stockings

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