Skilled Care

jadelpn, LPN, EMT-B

There are a number of different types of skilled care facilities. Generally speaking, skilled care can be defined as a long term care facility which houses non medically acute patients, that do have medical needs that need to be maintained on a long term basis.

Skilled care residents are all ages, come from all walks of life. They all have a story. Some more complicated than others. Skilled nursing is a passion. There are nurses who will tell you that they can't imagine doing anything else, but have the ability to if needed. Skill care nurses have the ability to take anything that comes out of or goes into a resident--any tube, any wire, any drain, anything--and make it work. Not only literally, but for the needs of the resident as well.

A number of skilled care facilites are amazing in the care that they provide. In the activities that the residents participate in. Of the ability to help a resident reach a higher level of functioning. What it can provide a nurse is the ability to hands on be able to maintain a number of clinical appliances that the resident needs to survive. Many skilled care facilities work with very little. It teaches a nurse to be innovative and think outside the box. Which can only help critical thinking skills in the long run.

If one is interested in mental health, residents who are brain injured takes a special type of theraputic communication. It takes a nurse who thinks on her feet. To assess issues before it becomes an even larger issue. It is something one loves or hates, but is a good way to think about communication and barriers to learning.

Many skilled care residents have trachs. This is something that again one loves or hates. However, a trach is something that a nurse should know how to care for and assess properly. Skilled care is a great way to learn this. When you are talking about using less to obtain optimal results, this is an "art" that is best learned with a number of patients over a long term.

A number of patients have some sort of feeding tube. This is interesting as they get both feedings and meds in this tube. It is always a good thing to be able to assess the site, the tube, and the function of same appropriately. Nurses who have been in skilled care for a long time, and it is a passion for some nurses, can show you things that are pretty amazing about those tubes. How to get them to function. How to make a patient comfortable with their tube.

Skilled care allows residents, to the best of their ability, to be involved in their own care. They allow them to be present and as active as they can be. There's a number of groups--resident advisory boards to Bingo to dances--that attempt to make life at least varied. From what I have seen, it is not all about in the bed 24/7/365 just get up on holidays kind of a place. Residents have a "life" and the nurses who care for them help them to live it to the fullest.

Skilled care is a viable option to seek employment. A nurse will get much more of an education than one would initially suspect. A nurse gets to work with a varied group of people, all ages, all functional levels, and help them to live their lives despite the bells, whistles and wires. In my opinion, it is an intensely gratifying form of nursing.

BSNbeauty, BSN, RN · Jun 1, 2013

What a wonderful article and a great way to educate us nurses. This Skilled nursing should be a specialty in itself if it isn't already. I've had the pleasure of working in a skilled facility and I thoroughly enjoyed taking care of those under my care. Most of them were residents but some of them were only their for a short period of time. It takes a special nurse to help patients recover when they are at their worst. The best part is seeing them leave in better heath than what they came in with.

OP, skilled nursing is blessed to have a great nurse as yourself!

BrandonLPN, LPN · Jun 1, 2013

Great article. Way too much stigma associated with this field of nursing. It really isn't as depressing as outsiders make it out to be. Many residents thrive in nursing homes. And many of them come from truly horrible living conditions in the real world, and have a much fuller life here then they ever could have isolated in their old homes. My facility has gardens, a wood working shop, a bowling alley, a chapel, a salon and lots of other stuff I can't recall now.

I'm still a little puzzled by the difference between "skilled" care and "long term" care. My elderly, confused residents who don't have a feeding tube or trach or something like that aren't really skilled nursing residents? Any nursing facility that legally has to have a licensed nurse on duty 24/7 is a skilled nursing facility, I thought.

Psychcns · Jun 1, 2013

I think this would be a great place to get those coveted med-surg skills. I did my first year and one half on a bone marrow transplant unit-way over my head. I survived. And went into psych.

It sounds like a skilled facility is a good place to get to know patients as well as help them with their care. Thanks for article.

jadelpn, LPN, EMT-B · Jun 1, 2013

Great article. Way too much stigma associated with this field of nursing. It really isn't as depressing as outsiders make it out to be. Many residents thrive in nursing homes. And many of them come from truly horrible living conditions in the real world, and have a much fuller life here then they ever could have isolated in their old homes. My facility has gardens, a wood working shop, a bowling alley, a chapel, a salon and lots of other stuff I can't recall now.
I'm still a little puzzled by the difference between "skilled" care and "long term" care. My elderly, confused residents who don't have a feeding tube or trach or something like that aren't really skilled nursing residents? Any nursing facility that legally has to have a licensed nurse on duty 24/7 is a skilled nursing facility, I thought.

Long term care is a place where people live who can't take care of themselves at home. It is usually divided into different levels of care, however, it is for people who can not totally care for themselves. Skilled care is people who have a skilled need (nursing or otherwise) and can live at a skilled care facility for a long term, or sometimes short term until they reach a functional level to be able to care for themselves. Some nursing homes have a skilled unit. A number of skilled care facilities are dealing with one issue ie: TBI.

YoungStud · Jun 5, 2013

What about LT ICU? Like Kindred Healthcare ICU? Would it still be considered long-term or skilled care?

jadelpn, LPN, EMT-B · Jun 5, 2013

I am not learned in LT ICU. However, I would assume that ICU requires skilled nursing. Perhaps there are a higher level of skilled nursing, but I am not familiar with it.

Long term care is not necessarily skilled care.

cjr2619 · Jun 10, 2013

Can someone please explain the difference between rehab, SNF, LTC, and skilled nursing facility? I am a nursing student and all of these different types of facilities seem to be one in the same but I don't think that is the case! I appreciate it :)

jadelpn, LPN, EMT-B · Jun 10, 2013

SNF=Skilled Nursing Facility, so that is the same thing. Explained above, however, skilled nursing is skilled in that people need a higher level of care than a LTC, which is Long Term Care, which can be just about anything, nothing but someone who needs supervision all have different levels and/or units.

All are the resident's "homes" although some from both types of facilities do progress to being able to go home or in a higher functioning residential treatment facility.

cjr2619 · Jun 10, 2013

SNF=Skilled Nursing Facility, so that is the same thing. Explained above, however, skilled nursing is skilled in that people need a higher level of care than a LTC, which is Long Term Care, which can be just about anything, nothing but someone who needs supervision all have different levels and/or units.
All are the resident's "homes" although some from both types of facilities do progress to being able to go home or in a higher functioning residential treatment facility.

Thank you so much! This def clears things up for me!

PeacockMaiden · Jun 11, 2013

I am currently a recent grad RN working in a SNF. I have been there 10 months. While I have learned some skills there, there is a limit on what you learn, due to the types/acuity of patients who go there and also the lack of training or mentoring. I work on the night shift with 60 patients and I am the only RN in the building. So if something happens (and something does every night), there's no one to help me or give me guidance if I don't know what to do. I worry about losing my license or getting fired all the time, since this facility uses nurses as a scape goat when something goes wrong.

Furthermore, some of the RNs who work there give me a nasty attitude when I ask for help with a skill. For example, in nursing school I only had the opportunity to start an IV two times, and that is definitely not enough practice to be proficient at it, especially in dehydrated elderly people. So when I asked the RN supervisor for help in placing an IV, she gave me a nasty attitude, saying, "Oh you should have learned that in nursing school...why don't you know how to do that, you are an RN after all"...

So, it's a good opportunity for a limited time, but within a year or less if you want to increase your skills you need to go to either a subacute, LTAC, or acute facility.

cjr2619 · Jun 11, 2013

I am currently a recent grad RN working in a SNF. I have been there 10 months. While I have learned some skills there, there is a limit on what you learn, due to the types/acuity of patients who go there and also the lack of training or mentoring. I work on the night shift with 60 patients and I am the only RN in the building. So if something happens (and something does every night), there's no one to help me or give me guidance if I don't know what to do. I worry about losing my license or getting fired all the time, since this facility uses nurses as a scape goat when something goes wrong.
Furthermore, some of the RNs who work there give me a nasty attitude when I ask for help with a skill. For example, in nursing school I only had the opportunity to start an IV two times, and that is definitely not enough practice to be proficient at it, especially in dehydrated elderly people. So when I asked the RN supervisor for help in placing an IV, she gave me a nasty attitude, saying, "Oh you should have learned that in nursing school...why don't you know how to do that, you are an RN after all"...
So, it's a good opportunity for a limited time, but within a year or less if you want to increase your skills you need to go to either a subacute, LTAC, or acute facility.

That's too bad you don't get the support you need. I start nursing school in the fall and I am trying to be extremely open minded about jobs when I graduate. I know the market is tough right now so I am open to anything. It seems like SNF is the only option for most new grads in my area.

It's great that you are working (so many new grads aren't) and you are almost at a year experience! Have you started looking into other jobs now that you've had some experience?

Skilled Care

About jadelpn, LPN, EMT-B

Share on other sites

More Like This

Care Plans Guide

NCLEX Study Guide

Specialties Guide