After 25 years as a nursing home administrator, Joan Robbins said it only gets harder.
Robbins oversees a team of nurses at Briarwood Nursing & Rehabilitation in Little Rock, a long-term care home for the elderly. Robbins said she loves each and every nurse on her roster, and she is proud of how they arrive early and stay late if a situation calls for it.
Finding people to fill her ranks is never easy, though, and she understands why better than anyone. Put simply, nurses at elder care homes are special people. They have to be.
“It is a strenuous job if you’re good at it,” Robbins said.
What do nurses in elder care homes do? The better question would be, “What don’t they do?” On any given day, a nurse may plan a care agenda for residents, monitor cognitive functions, analyze urine and fecal samples, oversee ambulatory function, and plan and assist with physical therapy — and that just scratches the surface.
What separates care home nurses from the rest of the crowd, what makes them special, is a necessary combination of compassion, communication and good old-fashioned mental toughness.
“It definitely takes a special person to be able to work in long-term care,” said Jennifer Siems, an administrator at Nursing & Rehabilitation Center at Good Shepherd in Little Rock. “You do have to have that compassion for the elderly and the understanding of these families.”
That is where the demands of an elder care home diverge sharply from other areas of nursing. A nurse must be able to clearly communicate with the families of residents, and that can often mean breaking bad news. Unlike a hospital stay, during which most patients are treated and eventually leave, the vast majority of nursing home residents will be there for the rest of their lives.
A nurse cannot simply monitor and record residents who have declining health. Nurses must also be able to distill patient information into understandable terms and then communicate those terms to the residents’ families.
Often, the news is not good.
“Going into long-term care, that’s the last thing anybody wants to do,” said Mike Nichols, an administrator at Sherwood Nursing & Rehabilitation Center. “That’s the last place [patients] want to be. The majority of the time, that’s the last chapter of their lives. You’ve got to be able to deal with all the emotions from all different varieties of backgrounds. You’ve got to be able to listen, then respond and treat them with empathy.”
Even if residents are still in reasonably good health, for many families, the act of sending a loved one to a long-term care home is the beginning of the grieving process, and it is the nurses who are on the front lines.
“Every family is going to respond differently when losing a loved one who is going into long-term care,” Nichols said. “We’ve had couples who have been together for 60 years, and they’ve made a promise to each other to not put themselves in a long-term care facility. It just gets to the point where it’s too much for them or their family, and they have to make that choice.”
Lance Stack is director of operations at Nursing Consultants, a consulting firm that assists nursing homes, and he said the demands on nurses go much further than clinical knowledge. At hospitals, for example, it is usually the doctor who visits with families and imparts bad news regarding a loved one. At long-term care facilities, that responsibility often falls to the nurses.
No matter how good a nurse’s education and training have been, there is really no way to prepare for it.
“We want to hone in on and try to capture those people that are going into nursing because they have a genuine heart to help people,” Stack said.
Elder care nurses are often thrown into situations where emotions run high, whether they involve residents, their families or both. Even with a full heart and a true sense of compassion, every nurse is human. To succeed in the field, nurses need a support structure.
“Mental toughness is very important,” said Emily Loy, director of nursing at Belvedere Nursing & Rehab in Hot Springs. “You can go to work, and there’s the likelihood that someone you may have known is going to die. It’s somebody you look to as family almost. Sometimes you are their only family. For the families, you have to help them get through it.”
Nurses in long-term care homes are often there for what can be the worst day of a family’s life. There is no instruction manual.
“Half the job is being able to talk to people and being able to communicate,” Loy said. “Honestly, it’s hard to find a nurse who can speak to people. Talking to the families, you have to be strong for them. You have to show that tougher side. That helps the families get through it.”
The importance of compassion extends to nursing home administrators. It is common to hear about workplaces trying to create a family atmosphere, but at long-term care facilities, that goes beyond a mere cliche. On any given day, nurses may be dealing with exhaustion, loss, compassion fatigue and anxiety. Administrators must make sure a staff can band together and support each other through situations that an outsider may not understand.
“It never gets easy,” Siems said. “It never becomes something that is routine. We just help each other within the facility for things like that. We build each other up to be able to break bad news to families. We become strong for the families. Then we work within our group of employees to help each other get through it. I know with my team, we all work together. I think it’s that relationship that the whole team has for the residents that makes it more comforting for the families and
residents.”
The question remains: Why? Why would someone begin their nursing career in elder care when there are so many other avenues that can be less demanding and less emotionally taxing? The quick answer is relationships. Even if a resident’s family is committed to staying in contact and making regular visits, there are still stretches of days and even weeks when a resident’s sole point of contact will be the nursing staff.
It becomes so much more than filling out charts and taking temperatures. Nurses build relationships and friendships with residents that can go on for years. It is not for everyone, but oftentimes, elder care nurses find themselves driving home totally exhausted but also completely fulfilled. The job is demanding, but the feeling at the end of the day can be priceless.
“A nursing home provides you with an opportunity for you to step in and have a patient you build a long-term care relationship with,” Stack said. “You’re caring for them day in and day out. You get to know them. You get to know their family. You get to know their needs. For people who have an actual desire to help people and to invest in their lives and then go to bed at night knowing that you’ve helped people, there’s no doubt. These nurses grow to love the people that they care for.”
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