The mantra frequently spoken by nursing staff in care homes is:
“Our residents do not live in our workplace, we work in their home.”
There is a unique professional balance to be struck when delivering nursing care in this setting, the ability to move fluidly from providing meaningful activity and maintaining personhood, to delivering sophisticated clinical nursing care for people living with the most complex health needs in our society. This care is delivered in environments that aim to be homely and requires tremendous leadership, skill and knowledge.
Registered nurses and nursing support workers who are employed in care homes frequently face the perception that they are 'second class nurses' and are 'wasting their skills'. These perceptions can occur right across the UK, as recognised by the NMC Chief Executive and Registrar, who clearly explains “there is no distinction between the standards, behaviours and skills we expect nurses to uphold, regardless of the setting in which care is provided.” (NMC, 2019)
The role of the care home nurse is key in the delivery of health and social care within all four UK countries, but the pivotal role of the nurse is frequently not articulated well. At the RCN there is recognition of the unique role of nursing in this sector and we believe there is an increased understanding of the need for national leadership and appropriate representation of nursing in the care home arena.
Increasingly within care homes we are seeing the development of the role of nurses in caring for people with frailty alongside other complex care needs, comorbidities, long-term conditions, disability and polypharmacy . This is often combined with end of life care for residents with a wide range of diagnoses and the additional support for family members.
It is important to remember there are more beds in care homes than in the NHS and care homes feature as one of the largest nurse-led services in the UK. There is increased potential for registered nurses to be working at their full scope of practice in this setting; providing comprehensive older age assessment, prescribing and advanced level practice. However, this should be matched by professional recognition and equal provision for a social care workforce strategy including pay, terms and conditions commensurate with other nursing colleagues.
This debate will explore whether the RCN should develop a strategy to promote the unique role of registered nurses in care homes.
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