A day in the life of a care home nurse

Care home nursing is a varied and stimulating nursing job, which allows you the opportunity to work with people at any stage in their life from adults with complex physical needs to older adults with conditions such as dementia and frailty. In this article we explore what the day-to-day life of a nursing home nurse is like.

People live in care homes for a variety of different reasons, but the underlying reason will be that they aren’t able to maintain their own safety and care in their own home.

This could be due to a physical disablement, mental health illness such as dementia, learning difficulty or simply old age.

Working in a care home nurse job you will work with the same people every day so you will form a bond with them and get to know their individual needs.

This will allow you to promote a positive environment and to encourage their wellbeing.

Living in a care home can become a very monotonous routine for an individual that previously used to live alone or had a much more active lifestyle, and as a care home nurse it’s your job to support them to remain as independent as possible.

Wellbeing and personal expression are key to a person’s happiness, and while it can be easier to treat a medical condition or provide pain relief, taking care of an individual’s emotional needs can be a lot more difficult.

Every person deserves excellent care, and it’s the job of the care home nurses, among others, to ensure standards are maintained and that the level of care given is appropriate to the individual’s needs.

A care home nurse should be continuously assessing each resident they interact with for signs of pain, illness and changes in mood.

They should update their care plan according to their changing needs and assess the effectiveness of the plans in place.

First thing in the morning

This time can mean at any point between 6am to 8am according to the size and type of the care home.

Handover is given first to update eon any changes in residents condition overnight.

Breakfast is often served before washes as this allows residents to eat before washes start as these can take several hours to complete, especially if you have a high level of dependency in the home.

Residents will be assisted by a team of care home nurses, support workers and care assistants with changing from their night clothes, washing and dressing and getting ready for the day.

Some residents may be bed bound due to their underlying conditions, in which case they will require assistance with a bed bath to maintain their hygiene needs and need regular pressure area care. Whilst residents are assisted with breakfast and washes, the nurse on duty will begin the medication round.

Medication rounds are often 5 times a day in a care home setting.

This allows for early morning medications that need to be given before breakfast, breakfast medications, lunchtime, teatime and then night time.

There is also the possibility that you will have residents who have time specific medications like those for Parkinson’s Disease as well as those residents who will have ‘as required’ or ‘PRN’ medications such as pain killers.

There will be some individuals who need assistance with feeding, so a support worker or care assistant may be called upon to support a resident to eat their meals. This can be a particularly degrading experience for a person if they have lost the capability to feed themselves, so it is the responsibility of everyone involved in their care to ensure that their dignity is maintained and that the individual feels supported in the situation.

In other cases where the person is unable to eat normally because of an unsafe swallow caused by a stroke or surgery, they may have liquid feed through a tube directly into the digestive system – a PEG (Percutaneous Endoscopic Gastrostomy) or PEJ (Percutaneous Endoscopic Jejunostomy) feed.

This will have been prescribed and monitored by the local community dietetic team.

This requires just as much sensitivity and will need either a care home nurse or support worker with experience in PEG/PEJ feeding to ensure it is administered correctly.

Mid morning

By the time everyone has eaten breakfast, had a wash and gotten dressed, it’s time for those that can to go into the day room or to go and take part in an activity.

Or, if they wish, they can stay in their room and watch TV, read or whatever activity they wish to do there.

The less mobile residents may need help to move from their wheelchair into the more comfortable day chairs.

This must be done with a hoist by a team of trained staff of either care home nurses or care assistants or a combination. Others will stay in their wheelchairs with the freedom to move about if they wish.

This may also be the time that activities are started, or the individual can go out with a friend/family or support worker if there is capacity in staffing.

The range of activity that an individual can undertake is assessed and managed by the care home nurses and care manager.

Some care homes offer residents the chance to be involved in community activities or go out do something active, but all external activities will vary between care homes.

In-house activities may also be available such as bingo or music, and in some care homes there are on site facilities including hair dressing and beauty therapy.

Some smaller care homes will not have the same resources available to accommodate these services so will book hair dressers to come to the care home on a weekly basis.

A care home nurse or care assistant will help facilitate anyone who wants to take advantage of these services by making the arrangements for them.

Lunch time

The residents will have lunch at some point in the middle of the day, and again those that need assistance with feeding will have help from support workers and care assistants.

The care home nurse will usually be assisting with another medication round during this time, as well as providing care to those residents who can’t leave their beds and require a more expansive care routine.

There may be a need to communicate with a GP or a Social Worker if there is a change in an individual’s condition.

Other healthcare professionals are frequently involved in the care of one person, so it’s essential that the care home nurse ensures all information is communicated effectively with the multi-disciplinary team.

In the case of an unwell resident, it may be that they will need transferring to hospital to receive urgent care, which will be arranged by a care home nurse. This process may also involve notifying the family / relatives of the hospital transfer.

It’s key that the care home nurse can communicate effectively with all parties involved in a sensitive and understanding manner.

In the afternoon, residents may choose to rest either in their rooms or in the day room.

In some care homes, care home nurses may be able to help residents with individual hobbies such as gardening or crafts.

Being a care home nurse is as much about providing nursing care as it about offering companionship and facilitating an individual’s interests. Encouraging a feeling of independence can be a big boost to the wellbeing of an individual.

Evening

After an evening meal, residents will usually be helped back to their rooms and either into bed or to watch tv if they are able.

The care home nurse will also ensure that the evening medication round is completed. In all care home environments, each resident will have their own room, usually en-suite, which helps to promote a more independent lifestyle and feeling of control.

All residents rooms have a call bell system but the resident may not be able to utilise it correctly owing to their underlying condition. This is especially true for individuals in the advanced stages of dementia.

These residents will require extra checks to ensure that they are safe as they will not necessarily be able to call for help.

There will be care home nurses on duty 24 hours a day, so there may be a handover to complete at the end of each shift.

Some residents in a care home may be reaching the end of their lives. It is an every day part of nursing home nursing that you will care for the dying and those approaching the end of their lives.

It may be that you will be required to set up syringe drivers or give additional doses of medications that will help manage symptoms associated with dying to keep a resident comfortable in the last days and hours of life.

The level of skill and ability to support a resident to have a dignified death is not something that can be underestimated.

Working in a care home nurse job can be extremely rewarding, but also emotionally involving.

You will need stamina, and the ability to be a good liaison between family, relatives, other healthcare professionals and the residents.

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