The Role of a Registered Nurse in a Skilled Nursing Facility

• Skilled nursing facilities (SNFs) are a critically important, and often overlooked, part of healthcare delivery.  
• SNF RNs are responsible for patient assessment and monitoring, care planning and coordination, medication management and administration, and wound care and infection control. 
• However, high patient loads and staffing shortages can make the work challenging. 

Skilled nursing facilities (SNFs) are a critically important, and often overlooked, part of healthcare delivery. SNFs provide long-term and transitional care, operating in the “third space” that supports patients who need more care than home health can offer, without the intensity of a hospital setting.  

With Baby Boomers aging rapidly, SNFs are essential to providing care to a large section of the population facing increased healthcare needs. While nursing facilities sometimes struggle with public perception, they provide an indispensable service and strive for a home-like environment for their residents. Yet, many are challenged by significant understaffing, limiting their ability to meet growing patient demand. 

Unfortunately, many nursing schools focus on hospital-based training, leaving future registered nurses (RNs) underprepared for the unique demands of SNFs, or entirely uninterested in working in a nursing facility, where their skills are increasingly needed. Let’s explore the critical role that RNs play in skilled nursing facilities and why their expertise is now more vital than ever. 

Key Responsibilities of RNs in a Skilled Nursing Facility 

Patient Assessment and Monitoring:

Upon admission to a SNF, the RN conducts a comprehensive head-to-toe assessment, examining the resident’s physical, mental, and overall health status. During the assessment, the RN records vitals, height and weight, mental status, and skin condition, which will be routinely monitored to detect any changes. This establishes a health baseline that guides the resident’s care throughout their stay. 

The RN also acts as a liaison between family members and healthcare providers, ensuring that changes in the resident’s condition are promptly communicated and directives from physicians and nurse practitioners are accurately followed. 

Care Planning and Coordination:

The RN’s role in care planning varies by facility, but all nurses working in a SNF collaborate with an interdisciplinary team that includes directors, administrators, physicians and their offices, and floor staff. They also ensure the care plan is followed accurately.  

Medication Management and Administration:

Some SNFs require RNs to pass medications while simultaneously assessing and monitoring residents, but all RNs have a supervisory duty to ensure correct medication administration using the nursing process. 

Generally, RNs work with a team of LPNs to complete medication administration. RNs ensure proper protocol is followed during medication administration and that physician orders are carried out accurately.  

Wound Care and Infection Control:

LPNs, who are often educated by RNs, complete many wound dressings. Strong educational skills are necessary to ensure proper care delivery. However, RNs lead the pack when it comes to infection control. They are a source of education for staff members on how to properly execute infection control practices. 

Enhancing Quality of Life and Patient Advocacy

Emotional and Psychological Support:

While SNFs can be a source of stress and emotional turmoil for residents, RNs provide day-to-day care of the physical and mental well-being for residents. RNs can offer direct support or provide on-the-spot education to other staff members on how to assist a resident with a difficult transition or other daily emotional and psychological issues. Soft skills are essential for this job duty. 

Advocacy for Patient Rights and Autonomy:

RNs work as liaisons between family members, physicians, and residents. They should take into account the residents’ wishes and provide education to family members on their options (such as hospice, palliative care, surgical options, medications, etc.). RNs are often the direct line of communication between resident and physician and should communicate clearly the residents wishes.  

Promoting Patient Independence and Rehabilitation Goals:

RNs work with an interdisciplinary team of physical and occupational therapy teams and reinforce teaching by the PT and OT to encourage maximum rehabilitation potential. The RNs educate certified nursing assistants (CNAs) to ensure residents’ independence is promoted on a daily basis. 

Challenges Faced by Skilled Nursing Facility Staff 

High Patient Load and Staffing Shortages:

While staffing has always been a challenge, SNF staffing has been decimated in recent years due to the COVID-19 pandemic. Recovery has been made even more difficult by the mass exodus of qualified LPNs. Staffing ratios have been implemented by the Centers for Medicare and Medicaid Services (CMS), but SNFs continue to struggle to meet the mandated numbers while admissions roll in. 

Complexity of Care:

SNFs are seeing an increase in patient acuity due to growing demand and an increase of residents presenting with more complex medical needs. Wound care, Bipap machines, dialysis routines, central lines, and countless comorbidities make it more difficult than ever to care for residents’ physical and medical needs.  

RNs need to be educated in a variety of conditions to properly care for each resident and identify their unique needs. Nurses need to rely on their care team to communicate changes in conditions or concerns so they can obtain physician orders accordingly. 

RNs must be equipped to deal with day-to-day patient care needs as well as reacting appropriately to emergencies within the facility (injuries, decline in condition, etc.).  

SNFs are required to balance the needs of the residents as well as the demands of their family members while also following CMS guidelines.  

Emotional and Ethical Challenges:

With the skyrocketing acuity of SNF populations, nurses face difficulty dealing with the stress of balancing their roles within a SNF as direct care employees and supervisory duties. Increasing Alzheimer’s Disease and dementia diagnoses and residents with varying behavioral concerns can put staff at increased risk for compassion fatigue due to unrelenting care needs.  

Essential Skills for RNs in Skilled Nursing Facilities

• Clinical Skills and Attention to Detail: An RN working in a SNF should be equipped with a broad range of clinical knowledge to deal with a variety of medical concerns. They should also be organized and able to adapt to changing situations quickly.  
• Communication and Teamwork: The RN should have strong communication skills to ensure proper delegation to the care team and effective staff education. Teamwork is essential to a smoothly running SNF. An RN working in a SNF should also have strong management skills to ensure proper care delivery from the direct care team.  
• Empathy and Compassion: SNF RNs should have strong empathy and compassion to navigate stressful transitions of care for the resident population and their family or caregivers.  

The Bottom Line

RNs in skilled nursing facilities must balance clinical expertise with compassionate patient care and leadership. As SNFs continue to evolve to meet the needs of an aging population with increasing health complexities, the importance of RNs cannot be overstated.  

These professionals provide essential assessments, coordinate comprehensive care plans, ensure safe medication management, and act as key advocates for residents’ well-being and rights. Despite facing staffing challenges, rising patient acuity, and emotional fatigue, RNs remain dedicated to enhancing residents’ quality of life and promoting rehabilitation and independence. 

To support the vital work of RNs in SNFs, more attention needs to be directed toward adequate staffing, ongoing training, and recognition of their indispensable contributions. 

Read More