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Some Thoughts on Care in Nursing Homes

Published February 16, 2013 6:12 PM by Frank Visco

A few months back, I wrote about the bad rap psychiatric nurses get amongst other specialties, resulting in a line of thinking that goes "psych nursing isn't real nursing." It's an unfair bias for sure, but it exists nonetheless.

Recently, I've begun to realize there is another peer group that the bulk of nurses seem to look down upon - the nursing home nurse. Once again, the derision is understandable. It is common to see admits from nursing homes with severe pressure ulcers, hygiene issues, and a slew of other "preventable problems." And infections like MRSA or C. diff are usually just assumed for such patients, as they almost always seem to go on immediate contact isolation.

At the same time, although I've never observed or rotated into a nursing home, I expect it must be a very difficult working environment. Many of the patients I've cared for in the hospital who have come from nursing homes are very dependent and often immobile, and, assuming nursing home staff are as understaffed as hospital nurses can often be, I imagine it can be quite a difficult experience.

There probably aren't many easy patients in nursing home facilities, and while I'm not naïve enough to think some of the care in such facilities is lacking, I'm also not jaded enough to outright assume a nurse is solely to blame just because a 300 pound immobilized patient gets a bed sore after two or three months.

In the end, it just seems like a really tough job, and I feel bad for the good, hardworking nurses in those facilities who get a bad reputation. I know it can be very easy to point fingers at those men and women for certain things, but they are doing vital work for a needy and often difficult-to-care-for population, and so I think there's something to be said for that.
posted by Frank Visco


I think any area of nursing offers its own unique skills. An ICU nurse couldn't go work at a skilled nursing facility and be instantly successful. Nor could they go to a psychiatric facility and have the same competence as a seasoned nurse there. I think nurses need to respect each other as nurses and not as subgroups. The reality is that there are good nurses and bad nurses no matter the unit or subgroup, just as there are good people and bad people. I respect your appreciation for those who don't get a fair chance sometimes. Hope school is going well!

Lorenzo Ortega March 3, 2013 8:36 PM

After reading this,  I thought I would comment that not all pressure ulcers are preventable.  It is true that Nursing homes take the brunt of not providing care.  I work with two surgeons in an Out patient wound care setting and have often told families that come in the office this.  Thats not to say that some pressure ulcers can be prevented and should.  Often, these patients in nursing homes are in there last stages of life.  The skin is the largest organ on our body.  When you start to see the skin start to breakdown it is usually because we have several other issues going on that causes us to have decubitus.  We dont see healthy people with skin issues in our office.  I worked as an LPN years ago in a nursing home.  We were always understaffed and the patients were total care.  Its a shame that the US doesnt value its elders.

Penny Pahis, Out Patient wound Care - BSN,WOCN, Mcleod March 2, 2013 7:05 PM
Florence SC

Frank I read your post again and realize you were not bashing but it botgers me long term care nurses are thought to be less nurses. I will advocate for them whenever an opportunity presents itself.

pam dyer, long term care - rn, NEC February 23, 2013 12:27 PM
spfld OH

Oh Frank you could not be more wrong! Nurses who work in nursing homes work so very hard! I am not sure why folks think these "nursing home patients" came to the hospital with pressure ulcers, the fact is the nursing home usually sends a patient to the hospital with fully intact skin! It is the poor  care they get while in the hospital that causes them to get stage 2, 3, 4 and unstageable pressure ulcers. It is easy to place blame on the nursing home nurse because you see the nursing home nurse as "unglamorous" but you should know these nurses work in nursing homes because they choose to, get your facts straight. They are proud of the job they do and should be recognized! Long Term Care Nurses work hard to prevent pressure ulcers. Hospitals need to do thr same. Nurses should lift each other up instead of putting each other down. I am a nursing home nurse. I also used to work in a hospital emergency room. I chose to leave the ER because my standards were higher than the care that was given. The nurses talked about the patients terribly & the manager lacked the ability to lead. Long Term Care Nurses Rock!

pam dyer, nursing home - RN February 23, 2013 12:18 PM
springfield OH

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