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This forum is for Health Care Professionals including student nurses, junior doctors and adult nurses.

Newly qualified RMN - Nursing home?

8 replies

Leapoffaith00 · 13/06/2019 18:47

Anyone work in a nursing home as a RMN?
I have never worked in a care home - most of my placements were adult inpatient or community based. However have worked with older adults for a short time.
Needing flexible hours to suit childcare needs, which is proving quite difficult.
A nursing home very local to me is willing to offer flexible hours and fully support me as a newly qualified nurse (Do not do preceptorship programmes).
I am worried about the lifting and moving part - I have a very weak back and I struggled massively when I worked as a health care assistant.
Can anyone tell me a little bit about 'a life in the role of an RMN in a nursing home' please?

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DevonshireDarling · 13/06/2019 18:54

When I've worked in nursing homes in the past as an agency carer, none of the nurses were expected to do any of the physical work, that's what the carers did. And even so, us carers aren't expected to lift people etc, gotta look after your backs Wink (put it this way, I'm 30 weeks pregnant in a care home and still managing to work on the floor)

From my experience the nurses did the handovers, the medication rounds, took bloods if needed and any other obs like blood pressure etc, insulin, oxygen therapy and inserted catheters etc. change dressings, manage end of life, ensuring carers turned residents etc and ordered medications. they would also do paperwork, deal with drs, family members etc and support the carers where needed.

I've never actually worked full time in a nursing home though, only residential. This is just my experience from when I did agency work in them. If I were you I would just ask, they should give you a copy of the job description? It's nice they want to be flexible as not a lot of homes can be like that and they expect you to work overtime to cover sickness etc.

Good luck! Smile

Leapoffaith00 · 13/06/2019 19:04

DevonshireDarling - thankyou so much, that was a very helpful read. I should have added - we do need to look after ourselves however, it's very weak these days so extra cautious with movement. I don't want to be in a position where it can become worse.
It sounds like you are doing amazing still working, well done :)
I have spoken to the manager and I am going to look around next week. I just didn't want to commit to something that I have no idea about. Thankyou :)

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AuntieO · 14/06/2019 08:27

Hi, I work in a nursing home and have done for most of my career following a short stint on a ward (qualified a few years ago). I'm adult trained so slightly different but I can give you my perspective if it helps.

Nursing homes are a completely different ballgame to the wards, in good ways as well as bad. The good outweighs the bad for me and I prefer nursing homes in general as although still under immense pressure, I get more time to provide quality care. I really enjoy my job and the people that I look after. Older adults are incredibly resilient and generally, a pleasure to care for. It's so satisfying getting to know your residents so well that you can spot if something is wrong instantly.

You will have to quickly get used to being "in charge" and making quick decisions on your own. You don't have doctors onsite and it can be difficult to decide which course of action is best at times e.g ringing a GP/ambulance/out of hours. Trust your instincts, they will help you out so much.
Listen to your care staff if they have concerns about a resident, they are your eyes and ears and will spend much more time with residents than you do.

Also, get used to delegating, you can't do it all yourself and your paperwork needs to be done unfortunately.
Thankfully, services are expanding in community and there are lots of different initiatives now to support nursing homes. Will be different in each trust but generally these services are being rolled out everywhere.

The perception of nursing home nurses is finally starting to change and we are now(finally!) being recognised as autonomous, multi skilled practitioners. Do not listen to those who tell you that you will become de-skilled, this is nonsense and those who say it have probably never worked in a nursing home Wink

You will learn a variety of skills, quickly, as older resident populations will generally have multiple co-morbidities. Ask what training the home offers, it varies widely and can really make a difference. The more skilled you are, the less you have to rely on district nursing etc. There is nothing more frustrating than being the only nurse on and not being able to fix something right then and there because you aren't trained.

I would make sure that you work in a place where you are not the only nurse and don't get left alone and in charge until you feel very confident.
If they say they are willing to support you as a new nurse, ask how. How long will you shadow someone for? How long will it be till you are left as nurse in charge?

Re lifting etc: generally the nurses do medicines, OBS, wounds, palliative care etc, however in my experience, nurses can be told to cover for care staff and work the floor when short staffed. This varies from place to place but is generally standard practice. I would ask if this happens in this home and explain your concerns re your back issues.
Good luck with everything and congratulations on completing your course! Smile

Leapoffaith00 · 14/06/2019 09:48

AuntieO - thankyou so much, your post was very helpful indeed!
The main thing that I am concerned about is not have the clinical skills compared to a general nurse. However I have heard there will be additional training. In this particular care home, the manager explained if there was a particular clinical need such as peg feed, they would have someone come in to train them all. I feel it takes me a little amount of time and experience of doing something new, I would be worried not having someone more experienced being around in a particularl skill. Also if there is no GP (like there is on wards), it's my judgement when it comes to deterioration of physical health in where I'm not sure I'm experienced in. Mental health deterioration I am. I sound petrified don't I? I am!! It's the unknown and the unexpected. I have all of the fundamental values of a good nurse. I love being in a position where I can show compassion, empathy and support someone's needs. I enjoy working with older adults. Older adults and little people. Its the ages in between tbat are a challenge. It's the decision making that I'm so scared about. I know once I know something and feel confident, I grow with confidence. I would love to learn more skills around supporting physical health. Like I said, I'm so scared of making decisions.
I will ask all of those questions when I go along to look around on Tuesday.
It's 4 miles from my home. Flexible working hours. I'm struggling to find a position that fits my childcare needs so it's perfect. I just want to enjoy my role too. I'm not sure what the salary is compared to the nhs. Could you advise me on this? Not that its a concern, I just want to enjoy my role and make a positive difference.
Thankyou for your help, I really appreciate it.

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AuntieO · 14/06/2019 11:47

No problem, it's always nice to have an insider perspective and I was lucky to have very supportive colleagues when I started out 😊
It's normal to be anxious as a newly qualified nurse, you'll feel like that wherever you work. Being mental health trained will actually be a bonus in a lot of ways as you'll be working with people who have dementia and will come across lots of other mental ill health too. I feel at a disadvantage sometimes when I work with people who have less common mental illnesses. I have said many times that I would love to do an extra qualification in this area at some point.
Re physical health knowledge: all nurses will have gaps in their knowledge due to the large variation of placements. Things like PEGS, tracheostomy etc only come up so often so everyone is new to it once. They have to offer training for something you aren't competent in.
Everyone is terrified making decisions at first(still am sometimes), just try and relax into it and trust your instincts. If you feel something is wrong, then it probably is. Don't be afraid to ring the GP if you're worried. Also, talk to family too to manage expectations. Most of the time, the aim is to keep people out of hospital and at home so that becomes your focus. Palliative care is a major focus within nursing homes so you will quickly gain knowledge in that area.
You'll learn from experience and more than likely, your mistakes at times. This is normal! That is why you should be supported as a new nurse and given appropriate training. Ask questions and try to make sure you get to work with another nurse for at least 1/2 weeks shadowing.
Depending on the size of home, you should probably always have another nurse working with you.
Our ratios are generally 2 nurses over 20 residents for at least part of a day shift but depends where you are and how many senior care assistants there are and what they are allowed to do.
Pay in the private sector is far better than NHS but generally no sick pay, only SSP. There are sickness/accident policies you can take out for a small sum each month, so that would cover most of your income if illness is an issue.

Leapoffaith00 · 14/06/2019 14:59

AuntieO - thankyou again, very helpful. Ok, I feel like I am ready to go and look around and ask those questions. I am very nervous. I feel compared to most of my cohort, I appear more so. I am looking forward to feeling less so, and working in a good team as this definitely helps. Not every placement was supportive of staff members. I hope it's a nice friendly place.

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itsabongthing · 14/06/2019 15:10

I would also suggest reading the CQC report of the home you are thinking of working for. It will be available on the cqc website. Should give you a feeling for whether it’s a good one or has any issues.

Leapoffaith00 · 14/06/2019 15:44

itsabongthing ok, thankyou for the advice, I will do that.

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