NP in Nursing Home/SNF

Specialties NP

Published

I've looked through and searched several pages but cannot quite find much about this topic with many good answers.

Does anybody here work as a NP in a SNF/nursing home/assisted living? There are many postings in my area through independent companies placing NP's in these facilities and was wondering how the work was, if pay any better or worse, what a typical day is and anything else that might be helpful.

I went rounding at a local SNF with one of my preceptors and it didn't seem like bad work.

Thanks in advance for any help!

Specializes in Pain, critical care, administration, med.

I am an NP and work in a long term and subacute facility. I am employed by a MD but work full time. I see all his residents but respond to acute issues for any resident. I do a lot to decrease readmissions. This setting is very different and you have to understand the difference of the nurses in this setting which can be frustrating. I practice very independently and the residents all know me. I love each one of them. This population is complicated and you are constantly learning with each day being different. I can tell you my boss pays me well some of the NPs hired by the nursing home is much less.

I love my geriatric patients and wouldn't trade them for anything.

2
Up Vote Up Vote ×

I just started doing this a month ago. It is not what I plan on doing long term, but for now it is working. I also had a background in home health. I love the autonomy and the freedom. I do more rehab patients than long term. My expectation is 15 to 20 daily. It is very doable. I set my own hours so long as my patients are seen.

Up Vote Up Vote ×
Specializes in Author/Business Coach.
I just started doing this a month ago. It is not what I plan on doing long term, but for now it is working. I also had a background in home health. I love the autonomy and the freedom. I do more rehab patients than long term. My expectation is 15 to 20 daily. It is very doable. I set my own hours so long as my patients are seen.

I'm entertaining the possibility of a position that encompasses seeing patients in the NH, rehab, and occasional home visits. I like the fact that it's flexible as far as hours and the autonomy and freedom I crave.

What downsides do you feel you have in this role? I think of silly things such as what do I do for lunch, I don't want to eat out everyday and would be practically living out my car during work. And what is your holiday/weekend requirement /call schedule like? I have another interview with the doctor soon, so hope to garner more information at that time.

Up Vote Up Vote ×
Specializes in Pain, critical care, administration, med.

I work Monday -Friday. No weekends or holidays. I take call 2 week nights every week and one weekend a month. I do go to 2 other facilities but only as needed to help out. Biggest issue is that you have to be willing to look the other way with the care issues. I love what I do and my boss just hate the crap that happens In nursing homes.

1
Up Vote Up Vote ×
I work Monday -Friday. No weekends or holidays. I take call 2 week nights every week and one weekend a month. I do go to 2 other facilities but only as needed to help out. Biggest issue is that you have to be willing to look the other way with the care issues. I love what I do and my boss just hate the crap that happens In nursing homes.

Can you elaborate more on that? I know what you mean, I've worked in those environments but would we not be at least culpable from a health perspective or are you talking smaller things like living conditions?

Up Vote Up Vote ×
Specializes in Pain, critical care, administration, med.

I am talking about nursing practice from the staff nurses.

Up Vote Up Vote ×

Hello Everyone,

Sorry to dig up a super old thread, but I found this discussion really relatable to my current situation. I am in the interview process of joining a big hospital foundation working as a SNF ARNP.

I was wondering if any of you have any advice for a new grad ARNP entering the world of SNF. My concerns are things that are out of my control, as in the nursing quality of care. The hiring manager who is also a ARNP mentioned that the nurses in SNFs are a "different breed" and "rough on the edge". She briefly mentioned there was an "incident" happened last year and the SNF is now down to 5 patients and is slowly climbing back to full census. I see this as an opportunity to enter the group, which was recently bought out by a major hospital foundation. I will definitely ask for more information regarding this "incident" that had happened.

I am also concerned if they expect me to see admissions, because the Medicare policy is that MDs must admit patients and prescribe a treatment plan. Thereafter, ARNPs are to manage the treatment plan. Is this true, how strict is it, are there exceptions?

The facility will train me for 2 months (3 months max), after that I am on my own Mon-Fri at the same SNF with physician visit 2 days/week. I am expected to round 14-16 patients daily. Is this all doable? What are my likely resources when I have a question about a diagnostic test or lab result (besides leaving the MD a message)?

Thank you in advance for your advice!

Up Vote Up Vote ×

Hi Vulpes Vulpes, I am in the same exact boat as you! I will be starting my new position in a few weeks. They are letting me start before the credentialing process is completed so I will have like a 45 to 60 day orientation, which I am pretty stoked about. I will be responisble for 2 facilities, one is owned by the hospital, and I will be working with 2 docs and they are in the process of recruiting for a third.

The docs are responisble for all new admissions, so my docs will be at the facilities to at least do those. I am the first NP to join this group so it will be a trial by error, not sure if we are going to have set rounding times during the week or not. Sorry I don't have many answers to your questions, just that I am in the same boat as a new grad!

Good luck!

Up Vote Up Vote ×

Hi Flipper628,

That is wonderful that your facility has physicians on-site at all days of the week, because my facility will have a MD only 2-3 days per week, the other days I will be solo. Should I need help or have questions, I will be utilizing the online messaging system (to specialists) or by phone to contact my MD and ARNP peers. The MD is also responsible for admissions per Medicare protocol.

While I am a cautious provider and wished the facility had at least a second provider with me at all times, I am relatively confident in succeeding because the foundation has in the past hired (2) new grad ARNPs, both have been trained well and are still with the practice >5 years later. This is quite telling, therefore, I see positive and promising results. I also got a sense of strong support and comradery between the other 5 ARNPs that round at other SNF facilities. During the panel interview, they all seemed very protective of our ARNP role within the SNF and to ensure we succeed as a mid-level group. Should any ARNP need help rounding or covering at their facility, they help each other out by traveling to their facility to help. With time, I look forward to contributing as well. I did not get this sense of comradery at any other practices I had interviewed with.

With that said, I have no doubt you will succeed with as much MD support as it sounds. You will learn so much from the best and do great, I wish both of us the best of luck!

If there are any seasoned SNF ARNPs out there willing to give Flipper628 and I some input or tips, we would greatly appreciate it! Thanks ahead!

Up Vote Up Vote ×

Just started my second week and I know I am really going to love what I do when I'm finally set free!

In addition to the two SNF we started discussing the possibility of inpatient consults, but this wouldn't happen until I am firmly secure in my primary role, but I think it would a great opportunity and would love to do it.

Up Vote Up Vote ×

I am also a new grad NP and will be starting at a skilled nursing facility next week. They are telling me that they are only giving me two weeks of orientation. Do you guys think this will be enough time??

Up Vote Up Vote ×

Its so awesome to hear Snf/ltc NP's who like what they do. More power and best regards. For me, I did not like it and I swear I will not do it again. I used to work for a large HMO. I had a panel I had to take care of which was a mixture of long term care and skilled pts. First, there are pros and cons. The pros: You cant beat the autonomy and respect (once earned). It is fulfilling to know you are treating people, helping families, and helping the staff nurses too (many of them are very nice and caring). You are being "productive" for the company too, coding the correct diagnoses for the max amount of medicare/medical dollars (ethically and truthfully of course). You have the peace of mind that the staff are there for any problems. Working with a supportive boss and MD are plusses too.

The cons: Working in a snf is like working in an acute hospital, and I dont like acute. I had to know when was the time to admit pts to the ER/hospital (always discouraged if possible); referring to specialists was highly discouraged; I had to know when to "skill" patients (admit to skilled days). And you are the provider ordering treatments like IV fluids, wound tx, P.T. orders, etc). MD is there for support, but you are running the show; had to know when to discharge from skilled days (as to not displease the HMO, the snf, and the families/pts). The admission and d/c from skilled days were practically an art form: You didn't want to piss off the HMO by having the pt stay skilled too long, but many times they demanded pts be discharged even though I didn't think pts were ready. The snf always fought against d/c from skilled days because they wanted the revenue. Sometimes, they went behind our backs and told families to contest (or "appeal") the d/c, gave them the 3rd-party governing body's tele number to call for this (getting too many appeals per year is bad for the HMO, and for the provider). Then you have snf's who want to discharge LTC pts out of the facility altogether in order to focus their business of mostly rehab/skilled pts because these generate more money for the snf owners. Then of course, there are many bad characters who work at the snf, eg some nurses, DONs, owners). You will also see the futility of life, pts on vents or are being kept alive with no hope of recovery because they didn't sign an advance directive, or I swear someone (like family) was benefitting financially by keeping them alive (sorry, I'm jaded).

I believe it takes a special NP to do this work; I'm sorry I am not one of them even though I wanted it badly to work out. I just dont have the patience or constitution for it, I got too stressed. My story seems to be a downer, but it sounds like many NPs on this blog like what they do.

Up Vote Up Vote ×
+ Add a Comment