Nursing home responsibilities for RN

VANurse2010 · Oct 22, 2016

I have a question. I'm a year out of school and work in an ICU at my hospital. I'm applying for a position at a travel/PRN agency in my area, and they some times send nurses to nursing homes. I was just trying to get some infor on what would be my responsibilities at a nursing home....it may be a dumb question but I've only ever experienced LPNs at these places. Assessments, and medication admin....I get. But if they have me work nights (which is what I work) is there an on call physician/resident or someone in case something goes awry? Or do they work with a hospital close by that I'd call? Other than that, it's just writing notes based on my assessments carrying out orders and maintaining their overall health?
also they send to some prisons too, so any info on that would be great too. :)

You may or may not have a second nurse or aid to pass meds, but probably not. Mostly likely you'll be doing the exact same job as every LPN in the building - meaning passing meds and doing treatments (i.e. pushing a cart). You will not be doing routine physical assessments on your residents unless they are covered by Medicare skilled nursing services (depending on the unit - this may be all, most, or none of your residents).

There will be a physician on call for your residents - either the physician himself or an on-call. Sometimes if your physician is affiliated with a local hospital (likely) you can call the hospital and have them page the on-call for that physician to the nursing home. Note that unless it's the physician taking his own calls the on-call will have zero clue about who the resident is or what their issues are, so make sure you have vitals, assessment findings, current meds, history, and allergies handy.

You will only be writing notes on skilled Medicare residents (depending on facility policy whether they require qshift or qday charting on those people - Medicare only requires qday) and others based on need or facility guideline (such as being on an antibiotic). It is not unusual to write almost no nursing notes on a unit without skilled residents. Otherwise on nights you'll be making rounds, passing midnight and 0600 meds (which can be substantial), file papers, check for appointments for residents the upcoming day, stock supplies etc. If you work in a good facility with good CNA coverage, night shift can be very chill in a nursing home - depending on the unit.

TheCommuter, BSN, RN · Oct 22, 2016

I worked as a nurse in the LTC/nursing home setting for six years...

There's no resident or physician in-house. If something's wrong, you call the on-call physician to obtain telephone orders for what's needed. If an emergent situation arises, you call 911 to send the resident to the nearest hospital ER via ambulance.

During nights, there's usually a smallish midnight medication pass and a larger 6:00am med pass. You may also be responsible for obtaining the 6:30am finger stick blood glucometer readings. You might also need to change tube feeding formula bottles, oxygen tubing, and hang the occasional midnight IV antibiotic or ProcAlamine.

Vital sign checks and charting need to be done on all skilled Medicare residents.

caffeinatednurse, BSN, RN · Oct 23, 2016

At the LTC facility I work at, the night shift RNs usually have: an RN supervisor or delegated charge nurse (who has their own hall to take care of, but is available via phone if you have questions or concerns), usually 1-2 CNAs per hall, and if you're lucky, an LPN (to pass meds or do treatments) or a medication aide (to pass meds). We have an on-call physician we can call if there's a fall w/absence of serious injury, or if we need new orders. If an emergency occurs, we call 911 and send the resident to the ER via ambulance. We still have to call the physician and get an order to send them out, and then notify the POA.

Night shift nurses are also responsible for doing chart checks (making sure that all orders in the chart have been noted, added to the MAR and put in the MD's mailbox for them to sign). They do the INR checks, since we do those in house. They usually pull all of the labs, because 1st and 2nd shifts rarely have time to do those. The med pass is usually non-existent until 6 AM, but they still have to give PRNs, answer call bells, help people toilet, do treatments, etc. There's typically a lot less staff around on night shift to help with these things, so that's one downside of working nights in LTC.

In terms of charting, if they're Medicare, we always chart: how they perform their ADLs (independently, 1 assist, 2 assist, etc.) including eating, drinking, bathing, toileting, how they ambulate, if they've been working w/PT or OT, if they're cooperative in their short-term and long-term goals, their VS, their pain level, any PRNs given, their general activity during our shift (did they visit w/family, did they go out for dinner, did they watch TV), any new problems that have popped up during shift, and if any old problems or complaints have been resolved. Keep in mind that I work on a short and long-term rehab unit, so the priorities of your facility may differ. We do an initial physical assessment when they're admitted, and then as needed (if a new symptom presents, or if we have to send them out, or they fall, etc.) We do weekly skin assessments on everyone, regardless of if they're Medicare or not. Those have to be done and charted each shift. Like the poster above me, we chart on certain residents if they're on ABTs, are known for seizure activity, negative behaviors (hallucinations, delusions, combativeness).

Try to work PRN for the same facility, if you can. It will be easier to work there, after you've developed a routine of your own.