Working in a Care Home

My first experience with the QNI was when I met Sharon Aldridge-Bent, QNI Programme Manager, at an event. During our conversations, we learnt about each other’s professional experiences.

Although I had heard of the QNI and Queen’s Nurses, during this day I learnt a lot more about the role of the QNI in community nursing. At this time Sharon was writing the Transition to Care Home Nursing resource and asked if I would be interested in contributing. I jumped at the chance to be involved, as it is such a valuable and much-needed resource for care home nurses. I subsequently became part of the external review panel and chapter editor for the ‘Adults at Risk’ chapter.

The reason I am writing this blog is because of a conversation I had with Dr Crystal Oldman about the challenges care home nurses can face and the vital part they play in community nursing. This is my first time writing a blog and I hope you find it informative.

How I got into nursing

I grew up in a care home run by my parents; my Mum was a nurse and now her care home legacy lives on, as she was my teacher and role model for care. This gave me insight into real nursing and care.

Growing up, I used to say I’d never be a nurse or work with old people. And yet, here I am 30 years later, a Registered Nurse, District Nurse and more recently an Independent Registered Nurse working with care homes.

I was lucky to grow up with 24 ‘Nannies and Grandads’, and now I am absolutely honoured to have been part of a care home family, to the point that when my parents thought they should give us a proper family Christmas, just the four of us at home, my brother asked during Christmas dinner if we could have a ‘normal’ Christmas at work next year…!

This experience enabled me to know the true value and experience of how a care home really is a person’s home.

Growing up I was stubborn! And I didn’t want to follow in my Mum’s footsteps, as so many people thought I should do. I made up my own mind and at 20 years old I started my Project 2000 training. Working on the care of the elderly ward as a newly qualified nurse, before going into the community and completing my Community Health Care Nursing (District Nursing) degree and becoming a DN sister, I then moved to a Care Home Facilitator role and found my passion relighted for working with and supporting care homes.

Next career steps

I moved into a social care charity as a Clinical Nurse Advisor for a short time and although this enabled me to work with care home nurses, I really missed the training that the care home facilitator role gave me.

This is where my independent nursing came in. I realised from previous job roles that there was a gap in the market for affordable training, delivered by a nurse not only with the knowledge, skills and experience of working with care homes but also understanding the rewards and challenges that care home nursing brings. I love sharing my practical experiences, but also giving care home nurses time to reflect and learn from one another, and take new or consolidated learning back to practice. I haven’t looked back since and have no regrets about the career path I have chosen.

The care home setting

You see, care home nurses work in care homes because they want to. They are highly skilled nurses, looking after the most vulnerable residents with complex health needs in the community. They have a huge wealth of experience working with their residents and become experts in their care.

However, care home nursing can be a lonely place to work; smaller homes may only have one nurse on duty, have short handovers and shift overlap so the opportunity for peer support can be minimal.

Continuing Professional Development (CPD) can also be challenging. Often smaller organisations will not have training or education departments and budgets, where training can be accessed and funded. Sometimes the care home nurse has to source, fund and attend in their own time.

If they want to learn a competency-based skill such as catheterisation or using a syringe driver, they have to find their own ‘competent person’, sometimes from another organisation who is willing to mentor them – easier said than done. Hence why District Nurses are sometimes asked to carry out these essential duties for patients living in care homes. The care home nurse is eager to learn but has little opportunity to have their competency assessed and use these skills often enough to keep their skills up to date.

But one thing is for certain, even though they have these CPD challenges and often work in isolation, they still love their job and want the best outcomes for their residents.

The bigger picture

There are approximately 50,000 registered nurses working in social care[1], with almost a third over 55 and may retire in the next 10 years. Across the health sector, recruitment and retention is a challenge, especially as the number of people needing community or residential care will rise to 1.2 million by 2040, almost double the 2015 figure (Nursing Times, accessed 18.9.18).

Support for care home nursing is rising – the RCN recently published a care home journey resource tool to support nurses working in care homes, and the QNI has published Transition to Care Home Nursing to support care home nurses’ CPD, as well as raising the profile of care home nursing as a career pathway. The QNI website has an introductory page to care home nursing; we need to recognise it as a community specialty as much as District Nursing, GP Nursing or Homeless Health.

Looking to the future

I work with care homes because I choose to, because I admire the staff that care and support some of the most vulnerable adults with complex needs in the community, and I absolutely believe that care home nursing should be recognised as a specialty in itself, and need support to increase recruitment and retention within this sector.

Next time you book yourself on training through your education department, think about the care home nurse that has to source, fund and attend in her own time.

Next time there is a media campaign about NHS funding, or hospital bed crisis, think about the care homes that support the NHS.

Next time you are asked to visit or assess a patient living in a care home, think about the care home nurse who is the expert in that patients care, and wants to work with you as part of the team to achieve the best possible outcomes for that person.

I am looking forward to continuing my career pathway supporting care home nursing, and raising awareness of not only the fantastic care and support they deliver but also raising the profile of this nursing career pathway.

This is only a taster of some challenges care home nurses face, so let’s not forget about the contribution care home nurses have in community care and embrace them as part of our teams.

Charlotte Fry, Queen’s Nurse

[1] Skills for Care, 2015