As a significant portion of our population ages—the number of Americans over age 65 is set to double by 2050, according to the US Census Bureau—the demand for skilled nursing facilities will also rise. If you’re a registered nurse (RN), licensed vocational nurse (LVN), or certified nursing assistant (CNA), there are many benefits to working in a skilled nursing facility San Diego, and like most workplaces, some drawbacks as well. To help you make the best decision based on your skills and goals, here’s everything you need to know about working in a skilled nursing facility.

Higher nurse-to-patient ratios

Compared to a hospital setting, the nurse-to-patient ratio at skilled nursing facilities is much higher. California law states that for intensive or critical care, the ratio should be 1:1, while for less intensive care, ratios can range from 1:2 to 1:8. At skilled nursing facilities, the ratio is closer to 1:15, but that’s primarily because patients are more medically stable, allowing nurses and CNAs to take on a larger caseload. Still, succeeding in a facility with higher nurse-to-patient ratios requires excellent time management skills and the ability to work efficiently.

Low turnover rates

While some patients stay at skilled nursing facilities for specific short-term care, a substantial portion of patients are there long-term, which means a much lower turnover rate compared to hospitals. There are benefits and drawbacks to low turnover rates. If you enjoy developing a friendly rapport with your patients, you will likely appreciate the chance to bond over a long period of time. You’ll also be able to understand their medical issues on a much deeper level, eventually intuiting their needs and delivering an exceptional standard of care. However, close bonds can lead to emotional distress if the patient’s medical situation takes a turn, and you will have to learn to deal with the grief of losing long-term patients.

Another benefit of low turnover rates is the chance to improve your pharmacology knowledge and skills by handling medication on a long-term basis. Knowing your patient well means being able to spot troublesome side effects or other complications that develop over time. 

Working as a team

Skilled nursing facilities serve a wide variety of patients, from long-term residents to short-term rehabilitation patients. As such, patients are under the care of a team that includes nurses, CNAs, doctors, nutritionists, therapists, social workers, and more. Camaraderie among the care team can make stressful days more enjoyable, and the “team effort” atmosphere can help relieve the burden of feeling you’re solely responsible for a patient’s wellbeing.

Daily variety

As a generalized internal medicine unit, skilled nursing facilities offer a wide variety of diagnoses to treat, and nurses and CNAs are accustomed to seeing something new almost every day. However, the environment in a skilled nursing facility is generally low-intensity, and the skills required are more concentrated, so you might not have the opportunity to frequently practice EKGs, responding to medical codes, or other acute skills.

CNA duties at skilled nursing facilities

Certified nursing assistants spend the most time with patients at skilled nursing facilities, providing basic care and assisting with daily activities, such as bathing, dressing, and eating in some cases. For rehabilitation patients, CNAs will assist with transfers, walking, and therapy activities. Because the care provided is so personal, CNAs must have compassion, excellent people skills, and a sincere desire to help others. 

CNAs will also be required to work with medical technology including software for billing, medical records, and health information. As with hospital settings, CNAs report to an RN or LVN, and since they might be the first to notice a patient concern or issue, it’s imperative that CNAs have outstanding communication skills to ensure the care team is aware of any problem that might arise.

RN and LVN duties at skilled nursing facilities

Registered nurses are responsible for more complex care and treatment at skilled nursing facilities, such as taking blood samples, inserting IV lines, administering medications and injections, evaluating vital signs, and monitoring each patient’s health and mental well-being. RNs are also responsible for determining treatment plans for aging residents with long-term medical conditions, and ensuring the care strategy addresses their needs.

Registered nurses also have important management roles at skilled nursing facilities. LVNs and CNAs report to them, and they are in charge of delegating and directing support staff while monitoring the overall quality of care. In addition to direct care and management, RNs act as educators and patient advocates, explaining treatment plans and care options to patients and their families. RNs will also be the ones to inform family members of any changes in the patient’s condition or if they need further treatment. 

Duties for licensed vocational nurses are similar to RN duties, including basic nursing and medical care such as checking blood pressure, changing bandages, and inserting catheters. LVNs report directly to RNs and are responsible for communicating patient status updates. They also often supervise both CNAs and fellow LVNs.

Sample daily routine at skilled nursing facilities

Like hospitals, skilled nursing facilities offer round-the-clock care, so shifts are available during the day, mid-day, or overnight. Here’s an example of what the shifts might include:

Morning:

Older residents at skilled nursing facilities tend to wake up early, so the day will begin with CNAs helping patients shower, dress, and eat breakfast. Nurses coming in for the morning shift will also complete a hand-off of information from the overnight nurses, including specific patient or facility issues, and check supplies and inventory. After breakfast, nurses will do their rounds and check on patients, and afterward patients might have physical or occupational therapy to attend, sometimes requiring CNA assistance.

Afternoon:

After lunch, patients might resume therapy sessions, and nurses will make another round of patient check-ins to ensure there are no new issues to address. Most social activities at skilled nursing facilities take place during the afternoon, as well as visits from family and friends. CNAs are usually on hand to help with activities, and nurses might spend the afternoon or evening reviewing charts, updating data, and reviewing the schedule for the next day.

Evening/overnight:

The evening and overnight shifts at skilled nursing facilities are typically the quietest, but there is always the possibility of a sudden medical issue or emergency so CNAs, LVNs, and RNs will still have to be on alert at all times.

Working at a 5-Star Skilled Nursing Facility

If you enjoy working with older adults and developing close relationships with patients, a nursing or CNA career at a skilled nursing facility might be right for you. At Bella Vista Health Center, our facility is powered by a team of medical professionals who are devoted to helping each patient achieve optimal health and functional independence. For more information about joining the Bella Vista team, check out our career page or give us a call at (619) 399-7920.