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Is Grandma In An RN-ing Home?


This post is by CHMP’s Amanda Anderson, RN. More frequently than not, Amanda writes toward her simple goal, “I want nurses to start talking.” Here, she reflects on a recent newspaper article calling for registered nurses in all nursing homes, all day. Find more of her thoughts on her blog, This Nurse Wonders, and tweets, as @12hourRN.

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Only thirteen states require registered nurses on site in nursing homes for 24 hours a day, despite direct evidence of their benefit. Photo credit @tuddysgirl.

Please imagine my surprise, when I surfed to The New York Times yesterday evening in search of updated news on the Ferguson riots, only to be drawn to a sidebar highlighting the title, “Where Are the Nurses?

Could it be?! My trusty paper, oft neglectful of my prized profession, showcasing nurses in a headline story? A mix of fear (nurses walking out on Ebola patients), and curiosity (staffing, really?) pushed me to click the hyperlink so foreign from my initial target.

The article turned out to be about staffing, more specifically, an Illinois politician’s goal of getting a registered nurse into each nursing home for each hour of the twenty four in a day. Not an LPN, or a certified nursing assistant, a Registered Nurse. Well, shucks, this was a happy distraction.

The proposed bill, “Put A Registered Nurse in The Nursing Home Act,” hit Congress July 31st, and calls attention to the mountains of evidence for our presence in inpatient care – reduced risk and bettered outcomes. The article, sharing a paragraph of links to the evidence, goes as far as saying that to have a registered nurse in-house all day long, makes “care improve, but cost less.”

Incredible. Nurses, and nurses all day long, and all night long, directly leading to safer, healthier, less-compromised patients? And for cheap?

Jan Schackowsky, the representative fighting for this requirement, called out the obvious – the suspected 11% of nursing homes that lack a 24 hour registered nurse (only 13 states in the country require one all day) shouldn’t really be titled nursing homes. She suggests the tongue-in-cheek name: “well-intended residences for the incurably underattended to;” a quick browse of the reader comments attests to the sad truth of this title.

These residences often staff with licensed practical nurses, or nurses aides, but as the article clearly outlines, “…only registered nurses are trained and licensed to evaluate a patient’s care and conduct assessments when his or her condition changes, which can happen rapidly — and at 3 a.m.” Without an ever-present, licensed practitioner on site, these residences for convalescence have no business advertising themselves with our trusted title. Why is this reality so infrequently stated? Does our acquiescence to this false representation speak to our lack of definition as a profession?

Perhaps nurses need to start recognizing how important our registered work is to the preservation of our patient’s health and safety, and to start protecting our right to a safely staffed, and properly titled workplace. If the nursing home does not provide a registered nurse, the public should know about it – and they should know why our absence matters, as much as our presence.

I hope this bill gets made into law. But I don’t just hope for that; I hope Schackowsky changes the vernacular of nursing, too. With a registered nurse required, maybe “nursing home” will be replaced with “Registered Nursing Residence,” and the public, and patients, will begin to demand nothing less.

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Correction: “Associate nurse” was replaced with “certified nursing assistant.” Associate-degree nurses sit for the same licensing exam as Bachelor-prepared nurses, and thus, hold the title, “registered nurse.” For more information on the different types of nurses, visit allNursingSchools.com’s overview here

6 Comments Post a comment
  1. Jennifer #

    It’s nice to know that yet again, some of you RN’s have zero respect for LPN’s. Even when we’re helping you do the exact same job and getting paid less for our time and experience you still have the audacity to write this peice in a way that basically states we are NOT nurse. You should be ashamed, talking of nurses this way. Plenty of LPN’s run circles around RN’s. Thanks for taking nursing another step back- if our own kind doesn’t respect us, who will?

    August 18, 2014
  2. Thanks for your comments, Nanci. You are so right; I have a good friend who is studying in an associate’s program to become an RN. My error was a thoughtless oversight, and I apologize.

    While I agree with your correction, I disagree with your assumption that I dismiss the work of LPNs and CNAs. I agree, they serve many functions that are important to the care of patients. But the author of this article, and the legislation it describes is dead on — these professionals are not licensed to assess and manage the treatment of patients who are undergoing status changes. I can only speak from my experience as a practicing nurse in NYS – scope of practice clearly lists “Interpret clinical data” as the very first task an LPN may NOT perform: http://www.opwdd.ny.gov/scope-practice-licensed-practical-nurses

    If my mother was in a nursing home, and developed delirium, a fever, and bladder pain in the middle fo the night (clinical data), I’d like someone there with the legal power and skill to assess, triage, and administer prescribed care to her – a registered nurse. The substantial amount of evidence in the Times’ piece adds to that desire – patients simply fare better when a registered nurse is in charge of care.

    August 17, 2014
  3. Nanci #

    Furthermore you’re very dismissive
    Of the work that LPNs and CNAs do. Nursing will never gain anything if they can’t stop dismissing one another and being disrespectful. I guess the course not included in ASN that is in BSN is cattiness 101 ?

    August 16, 2014
  4. Nanci #

    I’m an ASN and I’m a RN I resent the implication that an associates degree is not an RN please do your research.

    August 16, 2014

Trackbacks & Pingbacks

  1. New Thursday Column: What Would #ThisNurse Say? | HealthCetera - CHMP's Blog
  2. Nursing Homes Without Nurses? | This Nurse Wonders

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