North London Partners in health and care

'I'm just a care home nurse'

Mary Rabitte
Unit care manager - Jewish Care

I choose this title as that's how people see me 'I'm just a care home nurse' but I know I and my sector colleagues are so much more. I have worked in the NHS for years and choose social care like many others. I didn't end up here as a last resort, a desperate attempt to pay the bills. I choose to work here. It's the first of many myths as how others see me. Registered nurses working in care homes have to be better than the rest. The need to be rounded, skilled, knowledgeable and effective. It is imperative to deliver good care. Why, because most of the time you're on your own. I have never had to make so many decisions, complex decisions and with one chance to get it right decisions.

The multiple comorbidities people live with are often overlaid with poor communication skills as so many of those in our care are living with dementia and so are complex to manage. From  day to day things change, peoples responses change, but when someone starts to deteriorate rapidly  the skills, based on years of practice, of  recognising  in that person the subtle changes in their behaviour, response or demeanour come to the forefront.

The ability to assess those changes and take action is what makes Care Home nursing so skilled. The longevity in the relationship with residents and the investment of building a relationship over time gives us, the care home nurse a unique relationship with our patients. The continuity in our care enhances our skill in observation and assessment in a very unique way. It means we see the most subtle change and can act fast to ensure appropriate and timely intervention. The tipping point can be avoided, admission to hospital and proactive management of 'crisis.'

Often there isn't a colleague to consider a dilemma with, or a peer group to turn to, or a rapid medical response, or immediate access to a doctor to consult about how to manage a situation. Care home nurses have to be 'on their toes' to ensure those in their care get the best. I'm not 'just a care home nurse' I am an intuitive, skilled, insightful nurse. I am skilled, I have longevity in my relationships and knowledge and insight into the needs of those in my care.

You can't just be a care home nurse overnight. It is not a job anyone can do; you have to have a broad experience. You are at the front line when things go wrong, you have to have experience of multiple condition management. Strong clinical decision-making ability and assurance and confidence in your practice. Your understanding of accountability and governance is paramount to underpin practice in this field.

Care Home nursing is so misunderstood and we are part to blame in not teaching others about what we do, who we are, the difference we make and the challenges we face. I wouldn't go back to the NHS now. I'm far too skilled and I really believe I would be frustrated not being able to practice with the greatest freedom and autonomy.

If we don't challenge others about their ignorance of our speciality, we only have ourselves to blame and only ourselves to be frustrated with. This is a speciality where nursing is nursing and there is lots of good to share.