Skilled Nursing Care Considerations

• Overview of the work environment inside a skilled nursing facility, including the role of RNs and CNAs as patient caregivers
• Review the role of a skilled nurse in the facility and the importance of interfacing with other health professionals. 
• Learn the key characteristics and skills of skilled nurse care to better prepare for this career as part of a direct care team. 

“If you love your work, if you enjoy it, you’re already a success.” – Jack Canfield 

Are you or someone you love considering working in a Skilled Nursing and Rehabilitation setting? Have you ever wondered what it would be like or any unique challenges that you may encounter in this position?  

How can you decide if Skilled Nursing is right for you? What would make me a successful Skilled Nurse?  

All of these are important questions to consider when pondering the idea of becoming a nurse in a Skilled Nursing or Rehabilitation facility.  

Overview of the Work Environment  

The patient population of those in a skilled nursing facility can vary, but many are composed of individuals recovering from a long-term illness or injury, especially post-stroke patients. There are typically more patients per nurse than in an acute care setting, and the patients are considered (generally) more stable than in acute care.  

Typically, there are usually 2-3 Certified Nurse Assistants (CNA’s or Nurse Aides) during each shift. The nurses work closely with the aides to ensure that the patients are cared for properly.  

Nursing assistants are extremely helpful at maintaining good communication is crucial to having a successful day and keeping both the patients and other staff members safe. 

Roles in Skilled Nursing Care and Importance of the Interdisciplinary Team 

The duties that make up most of the nurse’s time include medication administration, prescribed treatments, dressing changes, assessments, and all other comprehensive nursing duties.  

In a skilled nursing care, nurses can work with the patients long-term, which allows the unique opportunity to get to know them well, along with their families and loved ones. It also gives nurses a deeper perspective of how to care for the patients properly and maximize clinical outcomes, along with building trusting relationships with the patients.  

The nurse works closely with the interdisciplinary team to ensure all the patient’s needs are met. Both Physical and Occupational Therapists help develop a care plan that encourages the patient to perform their daily activities as independently as possible, with assistance or supervision by staff members.  

The patients are also encouraged to actively participate in their care. Providing emotional support for both the patient and their family is a huge part of the Skilled Nursing and Rehabilitation role.  

Patients are seen during the worst days of their lives and witness some of their huge accomplishments built on months of hard and painful work. Skilled nurses in this type of setting can directly impact the patient’s care and recovery, sometimes making these amazing accomplishments possible.  

In both skilled nursing and rehabilitation settings, there is typically one or more in house medical providers that oversee the patient’s care, which serves as the point of contact for any change of condition with the patient and medication management. 

Skilled nursing and rehabilitation are very fast-paced nursing roles that provide many opportunities to provide direct patient care and develop close relationships with patients. Some patients consider the nurses as close as family members due to the care they receive daily.  

Key Characteristics of Skilled Nursing  

The key characteristics needed for a nurse in this setting rely mostly on time management and prioritization. There is a great amount of patience required, as well as empathy, compassion, and understanding. The ability to handle a difficult, stressful situation in a calm, positive, and proactive manner is extremely important. 

Communicating effectively is imperative, and developing solid communication with the patients, their families, and the interdisciplinary team is required for success in these areas. It is also important to possess the ability to communicate therapeutically to both patients and families.  

Most likely, the nurse will encounter a difficult patient (or a person in a difficult situation), and it is important to not take things personally and exercise empathy and compassion. The ability to not take things personally can make or break any difficult situation nurses may be associated with in these types of settings.  

It is important to rely on fellow nurses for advice and to ask them to assist in caring for the patients if needed. Working as a team and knowing how to communicate effectively with everyone is the key to success.  

To decide if a skilled nursing position is the best choice for the individual nurse, nurses must think of the unique skills and background experience that they possess. The following are important questions to consider: 

• Have you worked in stressful situations and been able to produce positive outcomes?  

This is definitely a skill needed for a nurse working in a facility such as skilled nursing or rehabilitation.  

• Do you enjoy getting to know your patients and working with them and their families on a long-term basis?  

This position is perfect for developing long-term relationships and many life-long friendships.  

• Are you able to manage your time wisely and have strong prioritization skills?  

If so, this is exactly what this position requires. 

There are many ways to prepare oneself for a role in the Skilled Nursing/Rehabilitation setting. Nurses can contact the local Skilled Nursing facility and ask for a tour before your application or just go and check the place on your own.  

Nurses can tell so much about the organization from outside of the facility and so much more by observing any patients or staff members they observe. It would be a great idea to go to a few different facilities in the area and find the one that you like the most.  

It is always a great idea to ask to “shadow” a nurse there (follow them around to see if you would enjoy the position without the commitment). Each facility has reviews online, many of which are completed by staff members, which serves as a great tool to see how the facility is doing in regard to both customer and employee satisfaction.  

Also, the most recent state survey of the facility is available for you to view as well. You may also find good or bad news in these reviews and surveys, so beware and do your own research to form your own opinion of the facility using credible sources. 

The Bottom Line

One of the most important things to remember is how much of a difference you can make directly in the lives of your patients in the Skilled Nursing and Rehabilitation setting. You will have the unique opportunity to journey with your patients throughout their recovery and make a huge impact on their lives.  

You may find a role in skilled nursing care that you absolutely love that offers so much more than just a paycheck!  

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