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The Role of a Registered Nurse in a Skilled Facility

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A skilled nursing facility, also called a nursing home or long-term care facility, caters to patients who require around-the-clock care. This includes everyone from elderly patients to those with chronic or degenerative conditions and those recovering from traumatic injury or illness. While certified nursing assistants and licensed practical nurses provide much of the day-to-day care in these facilities, registered nurses play a crucial role in overseeing treatment and ensuring all patients receive the highest standard of care.

Unlike a hospital, where patients receive treatment for an injury or illness and return home after they recuperate, at a skilled nursing facility, the patients might not recover enough to live on their own. For example, many facilities specialize in geriatrics, caring for senior citizens with Alzheimer’s disease, dementia and other conditions that require constant monitoring. Some skilled nursing facilities also treat patients with traumatic brain injuries or degenerative diseases that leave them permanently impaired. RNs at these facilities focus on improving patients' quality of life and keeping chronic conditions under control.

Treatment and Care Plans

LPNs and CNAs are limited in the kinds of tasks they can perform, so RNs perform much of the more complex or invasive treatment. For example, they administer medications and injections, take blood, and prepare and insert IV lines. They also monitor each patient’s health and progress by evaluating his vital signs and assessing other indications of his physical and mental well-being. In addition, they determine the treatment plan for each patient and ensure the care strategy addresses the long-term needs of the aging process and the conditions with which he’s coping.

Supervising Staff

Under federal law, a skilled nursing facility must have at least one RN present for eight hours a day. Many only have one RN on duty at a time, and she frequently supervises LPNs, CNAs and other direct care support staff. She also ensures patients receive continuous care during shift changes. She typically has more training and experience than the other employees and may hold the title of head nurse or director of nursing. She plays a similar role to a hospital charge nurse or nurse manager, delegating tasks, assigning employees to specific patients and monitoring the overall quality of care throughout the facility.

Other Duties

In addition to direct bedside care, RNs at skilled nursing facilities also act as patient advocates and educators. They teach both patients and family members what to expect when dealing with the challenges of aging or the specific conditions the patient has and help them understand what they can do to contribute to recovery and long-term wellness. They also inform family members of any changes in the patient’s condition and confer with them regarding alterations to the patient’s medication or other treatment needs. In addition, they work closely with the facility’s resident physician to create and implement care plans, also notifying him if the patient’s condition improves or deteriorates.

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