Guide to Nursing Careers in Long-Term Care

Geriatric nursing in long-term care can prove a rewarding career with many roles and room to grow. 

Nurses are the heart of long-term care and older adults are a unique population with whom to work. They hold a long lifetime of stories and experiences. Long-term care offers many roles that allow nurses to care for this special population. 

Here is an overview of some of the roles that nurses may hold during a career in long-term care, including certified nurse assistants, floor nurses, nurse managers and administrators, nursing home rounders, nurse practitioners, nurse research scientists, and nurse educators.

Each role has a description of the typical education and responsibilities within a nursing home or long-term care facility.

Become a Certified Nursing Assistant

According to the National Association of Health Care Assistants, the main goal of a CNA (Certified Nursing Assistant) includes increasing the quality of life for older adults and other vulnerable populations. This role includes collaborating inter-professionally with all who serve residents in long-term care. 

Many older adults need help with activities of daily living. An important part of a CNA’s role is to protect older adults’ dignity through personal care. The caregiving role of a CNA is an honorable and rewarding profession. Many student nurses work in this role as they work to advance their education to gain experience in direct patient care.

Become a Floor Nurse (LPN/LVN or RN)

In the long-term care setting, a resident’s primary nurse (or team of nurses) is responsible for implementing and evaluating their daily care. This is a first-line direct care role for ensuring safety in all aspects of care from medication administration to monitoring status and communicating with all team members. The license required is either an LPN/LVN or RN. 

To become an LPN (licensed practical nurse), candidates must have at least one year of formal didactic coursework with clinical practicums is required. In California and Texas, these professionals are referred to as LVNs (licensed vocational nurses).

Some states have non-traditional routes to this role, accepting military experience or coursework from an RN program for an individual with an education in progress, or as a step in becoming an RN. A passing score on the NCLEX-PN licensing exam is required as well.

Becoming an RN (registered nurse) requires an AD (associate degree) or a BSN (bachelor in the science of nursing). Some states also offer a pathway for LPNs to become RNs through coursework. An RN is able to perform intake assessments, patient and family education, and act as a leader within the long-term care facility. 

Above all, the floor nurse is the heart of the unit. They are involved in every aspect of direct care. Physicians, advance practice nurses, therapists, nutritionists, and all members of the healthcare team depend on the floor nurse to share information regarding residents’ statuses at all hours of the day. Additionally, the floor nurse may also have a professional relationship with visiting family members, providing support and education.

Become a Nurse Manager or Administrator

Nurses hold many administration positions in long-term care. A director of nursing is a leader who is responsible for the executive functions required to keep a nursing home safe and in good financial health. They need to have excellent communication skills and be knowledgeable in healthcare, ethics, human resources, business, information technology, business, and marketing. This role may cover many responsibilities throughout the long-term care unit.

An MDS (minimum data set) nurse is another key role in long-term administration. They are responsible for ensuring that a proper assessment, the federally mandated MDS, complies with regulations. The MDS is an assessment of a resident’s function. This role involves teamwork including communication with staff and residents. This role is exceptionally important to monitor safety and quality of care. The nurse documents that all the residents’ needs are met. An RN, LPN, or APN (advanced practice nurse) can hold this position with the proper training.

Nurse managers and supervisors are also supervisors that typically hold a more clinical role in day-to-day nursing. They may also attend team meetings and other collaborative activities.

Become a Nurse Practitioner & Nursing Home Rounder

A nursing home rounder can be a physician or an APN. Frequently, a physician and APN work as part of a team to provide the most comprehensive care that both professions can bring to long-term care residents. A systematic review by Robin and Baker (2009) includes many study results reporting that when physicians and nurses both serve as part of a team, the residents have better outcomes. This means that fewer residents become sick enough to need the emergency room and acute hospitalization when residents benefit from a team that includes an APN and a physician working together. 

To become a nurse practitioner, a type of advanced practice nurse, special clinical training involves a graduate degree. Nurse practitioner programs include both master’s degree programs (MS/MSN) and doctor of nursing practice (DNP) degrees.

After a nurse completes their degree program, they will need to certify in their specialty. The ideal specialty for NPs in long-term care is the adult-gerontology acute care nurse practitioner.

Become a Nurse Research Scientist

Nurse research scientists assess ways to improve patient care. They do this by studying clinical interventions, nursing practice, interdisciplinary collaboration, and other topics. A nurse research scientist requires a graduate research degree (e.g., PhD in nursing). 

Nurse research scientists usually hold a position with a research institution such as a university. They collaborate with a long-term care facility for their research site. Information gleaned from research in long-term care can shape policy and practice to provide better care. 

Research is not necessarily done in all long-term care facilities. However, all long-term care facilities can benefit from research that is disseminated in nursing journals and other media.

Become a Nurse Educator

Every new nurse is oriented to the unit through formal and informal education. There may be classroom orientation for new employees to learn the facility’s policies and procedures, and clinical orientation to the practice area. Many facilities hire a nurse educator to welcome all new employees as well as to educate all staff to keep them current on best practices.

All levels of nurses benefit from education. Many long-term care facilities run their own CNE programs which provide both didactic and practical experience to train new CNEs. This is an excellent way to both educate valuable employees and for individuals to gain new skills and employment. 

Long-term care facilities are excellent clinical training sites for nursing schools. Nursing schools may place undergraduate or graduate nursing students in long-term care for clinical training. These students are supervised by their nursing professors who may provide formal lectures and debriefing after clinicals. 

A student’s experience in long-term care orients the next generation of nurses to geriatric care in the long-term care setting. This provides students with rich knowledge and personal experience that may influence them to choose a career working with the geriatric population in long-term care.

Cecile B Evans, PhD

Cecile B Evans, PhD

Dr. Cecile Evans is a registered nurse who holds a BA in psychology, a BSN, an MS (family nurse practitioner), and a PhD in nursing. She has experience teaching both undergraduate and graduate-level nurses and has worked in both clinical and bench research. She serves on many boards and has been an associate editor of Pain Management Nursing. In long-term care, she has been a primary care nurse, nurse practitioner, nurse research scientist, and undergraduate nursing instructor.

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