My first job as a Nursing Supervisor in Assisted Living

Difference between Assisted Living and Nursing Homes

If you’re wondering what an Assisted Living Nursing Supervisor does, look no further. I’ll take you through an Assisted Living Facility (ALF) Nurse Supervisor’s typical day in his or her shoes. I spent a total of one and half year working as a registered nurse supervisor at an ALF, and this was my first job as a nurse. Let me start by defining the distinction between an assisted living facility and a nursing home. At first, I believed that my duties as an assisted living nurse would be similar to those of a nurse in a nursing home. A nursing home is not the same as assisted living. Unlike in a nursing home, the nurse in an ALF does not visit each resident’s room to administer medication.

Assisted Living facilities have their own medication departments which is run by a medication supervisor and medication aides. The medication department provides medications to all of the ALF residents. Residents in an ALF are not bedridden; they walk with or without the assistance of a walker or cane. Residents are assessed upon admission for the need of a home health aide. If the resident is assigned an HHA, the aide will assist the residents with their activities of daily living. The aides also accompany them to the medication department on a daily basis. You can read the following article written by Claire Samuels to learn more about the differences between an ALF and a nursing home. Assisted Living vs. Nursing Homes | A Place for Mom

Nursing Supervisor’s Shift and morning routine at the Assisted Living

My Shift started at 7 am to 3:30 p.m. from Tuesday-Saturday. At the Assisted Living, we had a total of two nurses. The other nurse shift started from 9:00 to 5:30 p.m. from Sunday-Friday. My day started with making and updating the tray list for the residents who, in the event of illness, would receive food in their rooms. The Tray List would then be distributed to the kitchen staff.

Administering Insulin Injections

Additionally, all diabetic patients are seen by the nurse in the morning for insulin injections. Every day before breakfast, the diabetic residents would all come to the nursing office to have their blood sugar levels checked. I administered insulin to all diabetic patients as prescribed by their physician. Insulin was the only medication that nurses could administer. As stated above, all other medications required residents to obtain from the medication department. Residents may refuse to comply and fail to show up for insulin, in which case you must locate them and emphasize to them the importance of taking their insulin. If the resident refuses, the nurse must speak with a family member, and if they still refuse, then document the refusal of medication in patient’s medical record chart.

Admissions and Discharges

Following that, if we had any new admissions, we would see the new resident and complete the admission process. The admission process included a complete head-to-toe assessment, a discussion and completion of forms for advance directives including DNRs. The patient is then introduced to the home health aides, a home health aide care plan is provided, and the aide is instructed on what assisted daily activities the resident requires. Then, based on our assessment and after reviewing the hospital discharge papers, we would create an overall care plan, attaching it to the UAS assessment (which the UAS nurse completes) and uploading it to the computer. Then we’d make a new profile for the patient in the computer medical record system and enter his or her information.

Insulin & Lunch time for residents

All diabetic residents return to the office before lunch for blood sugar checks and insulin injections. They are then free to eat lunch. The Lunch Tray List is created/updated once more for residents who require Lunch in their rooms as well as those who are ill. We’d also make rounds during lunch and dinner to keep an eye on the residents in case of an emergency.

Emergencies

The nurses had to be prepared for any type of emergency at any time during our shift. The type of emergencies I handled were such as falls, hypoglycemia, fistula bleeding, choking, seizures, etc. Residents at ALF are at high risk for falls since they walk with a walker, cane, or without an assisted device. Therefore, falls are common in ALFs. The residents either trip or lose balance and then fall. If a resident fell, the nurse would go assess the resident. If the fall was severe and there were head injuries, the nurse would instruct staff to call an ambulance. Of course, we would stay with the resident to monitor them or stop bleeding until EMT help arrived.

Resident/Home Health Aide Supervisions and training

Another duty of an assisted living nurse is to supervise the home health aides. You must ensure that all home health aides adhere to the care plans for assisting the residents. There were quarterly and annual resident/home health aide supervisions that had to be completed. We completed a head-to-toe assessment of the residents during quarterly supervisions. There were done to ensure aides are assisting with ADLs such as bathing, applying creams, maintaining hygiene, etc. In addition, the RNs were in charge of training aides on fall prevention, choking, and other topics.

Other Duties of a nursing supervisor at assisted living

Other duties included assessing resident conditions and informing doctors. Either by adding them to the doctor’s to-see list or calling the doctor directly if an emergency occured. Doctors are not available 24 hours a day at the facility. Doctors visit assisted living facilities twice a week to examine the residents. So, in the event of an emergency, we usually call the doctor. Then, follow the doctor’s instructions to either send the patient to the hospital or monitor.

It is vital for nurses to have a high-quality stethoscope when assessing residents. You will need a stethoscope to assess resident’s breathing, heartbeat or bowel sounds if needed. It is easier to listen when you have a good stethoscope; otherwise, you will struggle to hear what you need to hear. A really good stethoscope I suggest, and I had bought at the start of my nursing school was 3M Littmann Stethoscope from Amazon.

Also, when patients were released from hospitals and returned to the facility, we assessed them and maintained current records in an electronic medical record system.

End of Shift Report from the Nursing Supervisor

Before leaving at the end of the day, we would need to create an End of Shift Report. This was sent to the nursing director and facility administrator to keep them informed of any emergencies or hospitalizations that occurred. Also, we had only one nursing supervisor working on the weekend. Therefore, we would also make the dinner tray list before leaving along with the end of shift report. Whereas on other days, the second shift nurse would be in charge of this.

Learning experience from my first nursing job as a nursing supervisor

Working at an ALF as my first job taught me a lot. I had the opportunity to practice hands-on nursing, starting with the fundamentals of checking vital signs. Then also administered insulin injections, provided colostomy care and simple wound dressings. I also developed my nurse-physician communication skills working as a nursing supervisor on my first job. Initially, I believed that as a recent nursing school graduate, I would not be able to hold the position of a nurse supervisor. However, nothing is impossible; you can pick up skills on the job, just as you would if you were working in a hospital.

Nurse Supervisors in an assisted living facility must be advocates for the residents and be patient and compassionate with them. Most importantly, the nurses’ primary duties included to provide excellent resident care while also effectively communicating with residents, families, and all of the healthcare staff.

P.S.- If you haven’t already, check out my other blogs. Click on the links below:

A day in the life of an outpatient Neurology Nurse – nurseamani

My journey to becoming a Registered Nurse in New York (nurseamani.com)