working in a nursing home essay

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What working in a nursing home taught me about life, death, and America’s cultural values

by Valery Hazanov

The first thing I noticed when I began working in a nursing home was the smell. It's everywhere. A mix of detergent and hospital smell and, well, people in nursing homes wear diapers. It's one of those smells that takes over everything — if you're not used to it, it's hard to think about anything else.

Being in the nursing home is tough. People weep and smell and drool. Sometimes you can go on the floor and hear a woman in her 90s scream, "I want Mommy."

But it's also ordinary — just people living together: gossiping, daydreaming, reading, watching TV, scratching their back when it itches.

For the past eight months I have been working as a psychotherapist with dying patients in nursing homes in New York City. It's an unusual job for a psychotherapist — and the first one I took after graduating with a PhD in clinical psychology. My colleagues were surprised. "Why not a hospital? Or an outpatient clinic? Do the patients even have a psychiatric diagnosis?"

The short answer is that I wanted to see what death looks and feels like — to learn from it. I hope that I can also help someone feel a little less lonely, a little more (is there a measure to it?) reconciled.

I haven't gotten used to the smell yet. But I have been thinking a lot about the nursing home and the people who live and die there, and wanted to share what I learned.

1) At the end, only the important things remain

"This is all I have left," a patient recently told me, pointing to a photograph of himself and his wife.

It made me notice the things people bring to the nursing home. The rooms are usually small, so what people bring is important to them. If they have a family, there will be photos of them (most popular are the photos of grandchildren). There might also be a few cherished books, a get-well-soon card, a painting by a grandchild or a nephew, some clothes, maybe flowers. And that's about it. The world shrinks in the nursing home, and only a few things remain: things that feel important — like they're worth fighting for, while we still can.

2) Having a routine is key to happiness

More on dying well.

It's never too early to start thinking about your own death

I'm a little lazy. My ideal vacation is doing nothing, maybe on a deserted beach somewhere. I look in terror upon very scheduled, very planned people. Yet I have been noticing that doing nothing rarely fills me with joy, while doing something sometimes does. Hence, the conflict: Should I push myself to do things, or should I go with the flow and do things only when I feel like doing them? Being in a nursing home changed my perspective somewhat: I noticed that all the patients who do well follow a routine. Their routines are different but always involve some structure and internal discipline.

I am working with a 94-year-old woman. She wakes up at 6:30 am every day, makes her bed, goes for a stroll with a walker, eats breakfast, exercises in the "rehabilitation room," reads, eats lunch, naps, goes for another walk, drinks tea with a friend, eats dinner, and goes to bed. She has a well-defined routine. She pushes herself to do things, some of which are very difficult for her, without asking herself why it is important to do them. And, I think, this is what keeps her alive — her movement, her pushing, is her life.

Observing her, I have been coming to the conclusion that it might be true for all of us. And I often think about her when I am debating whether to go for a run or not, whether to write for a couple more hours or not, whether to finally get up from the couch and clean my apartment or not — she would do it, I know, so maybe I should, too.

3) Old people have the same range of emotions as everyone else

"You are so handsome. Are you married?" is something I hear only in extended-family gatherings and in nursing homes. People flirt with me there all the time. This has nothing to do with their age or health — but rather with whether they are shy. When we see someone who is in his 90s and is all bent and wrinkled and sits in a wheelchair, we might think he doesn't feel anything except physical pain — especially not any sexual urges. That's not true.

As long as people live, they feel everything. They feel lust and regret and sadness and joy. And denying that, because of our own discomfort, is one of the worst things we can do to old people.

Patients in nursing home gossip ("Did you know that this nurse is married to the social worker?"), flirt, make jokes, cry, feel helpless, complain of boredom. "What does someone in her 80s talk about?" a colleague asked me. "About the same things," I replied, "only with more urgency."

Some people don't get that, and talk to old people as if they were children. "How are we today, Mr. Goldstein?" I heard someone ask in a high-pitched voice of a former history professor in his 80s, and then without waiting for a response added, "Did we poopie this morning?" Yes, we did poopie this morning. But we also remembered a funny story from last night and thought about death and about our grandchildren and about whether we could sleep with you because your neck looks nice.

4) Old people are invisible in American culture

People at the nursing home like to watch TV. It's always on. How strange, then, that there are no old people on TV.

Here's a picture I see every day: It's the middle of the day and there is a cooking show or a talk show on, and the host is in her 50s, let's say, but obviously looks much younger, and her guest is in his 30s or 50s and also looks younger, and they talk in this hyper-enthusiastic voice about how "great!" their dish or their new movie is, or how "sad!" the story they just heard was. Watching them is a room full of pensive people in their 80s and 90s who are not quite sure what all the fuss is about. They don't see themselves there. They don't belong there.

I live in Brooklyn, and I rarely see old people around. I rarely see them in Manhattan, either. When I entered the nursing home for the first time I remember thinking that it feels like a prison or a psychiatric institution: full of people who are outside of society, rarely seen on the street. In other cultures, old people are esteemed and valued, and you see them around. In this manic, death-denying culture we live in, there seems to be little place for a melancholic outlook from someone that doesn't look "young!" and "great!" but might know something about life that we don't.

There isn't one Big Truth about life that the patients in the nursing home told me that I can report back; it's a certain perspective, a combination of all the small things. Things like this, which a patient in her 80s told me while we were looking outside: "Valery, one day you will be my age, God willing, and you will sit here, where I sit now, and you will look out of the window, as I do now. And you want to do that without regret and envy; you want to just look out at the world outside and be okay with not being a part of it anymore."

5) The only distraction from pain is spiritual

Some people in the nursing home talk about their physical pain all the time; others don't. They talk about other things instead, and it's rarely a sign of whether they are in pain or not.

Here's my theory: If for most of your life you are concerned with the mundane (which, think about it, always involves personal comfort) then when you get old and feel a lot of pain, that's going to be the only thing you're going to think about. It's like a muscle — you developed the mundane muscle and not the other one.

And you can't start developing the spiritual muscle when you're old. If you didn't really care about anything outside of yourself (like books, or sports, or your brother, or what is a moral life), you're not going to start when you're old and in terrible pain. Your terrible pain will be the only thing on your mind.

But if you have developed the spiritual muscle — not me, not my immediate comfort — you'll be fine; it will work. I have a couple of patients in their 90s who really care about baseball — they worried whether the Mets were going to make the playoffs this year, so they rarely talked about anything else; or a patient who is concerned about the future of the Jewish diaspora and talks about it most of our sessions; or a patient who was worried that not going to a Thanksgiving dinner because of her anxieties about her "inappropriately old" appearance was actually a selfish act that was not fair to her sister. Concerns like these make physical pain more bearable, maybe because they make it less important.

6) If you don't have kids, getting old is tough

The decision to have kids is personal, and consists of so many factors: financial, medical, moral, and so on. There are no rights or wrongs here, obviously. But when we are really old and drooling and wearing a diaper, and it's physically unpleasant to look at our wounds or to smell us, the only people who might be there consistently, when we need them, are going to be either paid to do so (which is okay but not ideal) or our children. A dedicated nephew might come from time to time. An old friend will visit.

But chances are that our siblings will be very old by then, and our parents will be dead, which leaves only children to be there when we need it. Think about it when you are considering whether to have children. The saddest people I see in the nursing home are childless.

7) Think about how you want to die

José Arcadio Buendía in One Hundred Years of Solitude dies under a tree in his own backyard. That's a pretty great death.

People die in different ways in the nursing home. Some with regrets; others in peace. Some cling to the last drops of life; others give way. Some planned their deaths and prepared for them — making their deaths meaningful, not random. A woman in her 90s recently told me, "Trees die standing tall." This is how she wants to go: standing, not crawling.

I think of death as a tour guide to my life — "Look here; pay attention to this!" the guide tells me. Maybe not the most cheerful one, slightly overweight and irritated, but certainly one who knows a lot and can point to the important things while avoiding the popular, touristy stuff. He can tell me that if I want to die under a tree in my backyard, for example, it might make sense to live in a house with a backyard and a tree. To you, he will say that if you don't want any extra procedures done to you at the end, it might make sense to talk about it with the people who will eventually make this decision. That if you want to die while hang-gliding over an ocean, then, who knows, maybe that's also possible.

My father, who has spent the past 30 years working in an ICU as a cardiologist and has seen many deaths, once told me that if he had to choose, he would choose dying well over living well — the misery of a terrible, regretful death feels worse to him than a misery of a terrible life, but a peaceful death feels like the ultimate reward. I think I am beginning to see his point.

I am 33. Sometimes it feels like a lot — close to the end; sometimes, it doesn't. Depends on the day, I guess. And like all of us, including the people in the nursing home, I am figuring things out, trying to do my best with the time I have. To not waste it.

Recently, I had a session with a woman in her 90s who has not been feeling well.

"It's going in a very clear direction," she told me. "Toward the end."

"It's true for all of us," I replied.

"No, sweetheart. There is a big difference: You have much more time."

Valery Hazanov, PhD , is a clinical psychologist in Brooklyn. He is writing a book about his training to become a psychotherapist.

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Home Clinician Life Blog Working in a Nursing Home: 5 Ways LTC Makes a Great Career

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Working in a Nursing Home: 5 Ways LTC Makes a Great Career

November 21, 2023 — 6 min read

Last Updated on January 9, 2024

Is working in a nursing home the right career move for you? If you’re a nurse, CNA, therapist, or other clinician looking for a healthcare job , it definitely could be! And if you’ve never thought about working in a nursing home or other long-term care (LTC) setting, here are a few great reasons to give it a try.

What’s it Like Working in a Nursing Home or Other LTC Facility?

What’s it like working in a nursing home or other LTC facility? That depends on which type you choose!

Types of Long-Term Care Facilities

• The most common type of LTC setting, nursing homes provide care to residents who live on-site (usually seniors). This includes helping with daily life — things like getting dressed, bathing, eating, and taking part in social activities. You’ll also need to deliver basic medical care, like taking daily vitals, helping with medication, and providing emergency treatments.
• In a skilled nursing facility (SNF) , residents stay for a shorter period, but need more intensive medical care. Usually, SNFs provide care for people after they’ve been discharged from the hospital and before they go home. So, residents aren’t limited to seniors, but can also include anyone recovering from surgery, illness, or other serious medical conditions.
• Assisted living facilities provide a less intense level of care than SNFs or nursing homes. They serve as a social community for people who need some help in a safe setting, but who don’t need full-time attention. Residents may be able to prepare their own meals and plan their own social activities. Adult foster care or adult day care centers offer similar services.
• Life care communities and continuing care retirement communities (CCRCs) usually combine all of the services described above. These senior care facilities cover different tiers of care, ranging from people who need very little attention to constant supervision.  
• Independent living communities focus more on social wellbeing for residents who usually don’t need as much medical care. Group homes , adult family homes , and residential care homes provide similar services. They all serve as communities for a smaller number of residents who need help with daily needs rather than constant, skilled medical care.

What Kind of Jobs Are Available in Nursing Homes or Long-Term Care?

Who works in these facilities? They all employ registered nurses (RNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs). And SNFs also offer jobs for other clinicians, like physical therapists (PTs), occupational therapists (OTs) and speech-language pathologists (SLPs, or speech therapists), technologists, dietitians, social workers, cooks, and more.

Usually, RNs work as directors of nursing (DONs) or charge nurses who oversee other staff. Some states allow LPNs to fill this role, or to serve as assistant directors of nursing (ADONs). Most states require a certain amount of nurses and aides during the day, at night, or around the clock.

What’s It Take to Work in a Nursing Home?

Working in a nursing home or any LTC facility takes certain skills. You’ll need compassion, and the patience to help people who might not be able to take care of themselves. You’ll also need to communicate well with people who might have memory or mental health challenges. Because you’ll be looking after a number of residents at the same time, you’ll also need to be organized.

You’ll also need basic medical skills. You’ll be expected to follow treatment plans, provide medication, and help create diet plans. You should be ready to take vital signs, dress wounds, draw blood, and provide basic medical care. Nurses working in LTC settings should have advanced cardiac life support (ACLS) certification.

5 Benefits of Working in a Nursing Home or LTC Facility

If you have these skills — or if you’re willing to develop them — then you’ll find many benefits in these jobs. For instance:

#1: You’ll Be in Demand

Working in a nursing home means having your choice of jobs. As the number of seniors grow in the United States, the need for workers to care for them also grows. On top of that, many states are increasing the number of nurses and aides needed in nursing homes. All this adds up to plenty of career opportunities, many of which offer the chance to start immediately. It also means great job security. 

#2: You Can Offer Hope to People in Need

Besides looking after their physical needs and safety, working in a nursing home gives you the chance to provide residents with important emotional support, too. These are people whose closest family members may no longer be available. And they’re also usually nearing the end of their own lives. So, the chance to build a relationship with them and put a smile on their face can be very fulfilling.

#3: You’ll Make Great Relationships

Besides the chance to bond with residents, nursing home jobs also let you work in a community that emphasizes teamwork and close relationships. And that can help you develop team skills, as well as make new friends — the type that could last the rest of your life.

#4: You Can Have Flexible Schedules & Lots of Variety

Nursing homes offer more flexible schedules than many other settings. You can usually choose whether to work days or nights, or full-time or part-time. And that means you can take more time to spend with your family, take classes, or even work other jobs.

And LTC jobs give you more variety than the hours you work. Because you’re helping care for an entire community, you’ll work with people of all types, in many ways. That includes helping people pick the most nutritious meals, keeping a close watch on those with cognitive issues, providing emergency care to those with chronic conditions, and much more.

#5: You Can Gain Great Skills & Experience

All this variety provides another benefit, too — it helps you develop important skills. And this doesn’t just help make you a more well-rounded nurse or clinician. Whether you’re a nurse, CNA or physical therapist , these skills can also help you land other jobs in the future.

Because nursing home jobs are in such high demand, they can provide a good starting point for new aides or nurses who eventually want to work jobs that might be a little harder to get. And because a lot of nurses move on to other settings, nurses may be able to move into leadership roles relatively quickly.

Seeking new nursing career opportunities? Learn more about nursing with CareerStaff

Start Working in a Nursing Home or LTC Facility with CareerStaff

If you’re looking to start working in a nursing home or other LTC setting, we’re here to help. With a great lineup of benefits plus openings across the country, CareerStaff is the best choice to find your next career opportunity.

Take a look at our available nursing home, skilled nursing, or long term care facility jobs nationwide. Or simply fill out a quick online application to connect with one of our amazing CareerStaff recruiters!

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Why Do You Want to Work in a Nursing Home?

December 3, 2019 

As the United States population continues to age, the need for quality elder care will grow. One common living option for those who require a high level of care is a nursing home. Nursing homes are complex healthcare facilities with different departments dedicated to maintaining the physical, psychological, and emotional health of their residents. The Centers for Disease Control and Prevention (CDC) reported in 2016 that there were 15,600 nursing homes in the U.S., with about 1.7 million total beds.

To support all of their patients, nursing homes employ a diverse group of professionals. These employees may specialize in business, healthcare, or other disciplines. Working in a nursing home is a unique experience. In these environments, professionals with different skill sets collaborate with one another to improve the lives of senior community members. Continue reading to explore why nursing homes are rewarding work environments and the professional opportunities they offer.

What Are Nursing Homes Like?

No matter what hour of the day or night, there are nursing home employees awake and tending to the needs of residents. There’s often a great deal of activity, such as nurses making their rounds, maintenance staff preparing the facility for the next day’s activities, or finance professionals balancing the budgets. At their busiest hours, the halls and wings of nursing homes are full of movement, with residents heading out to activities, visitors stopping in, and staff members performing their daily tasks.

Jobs in nursing homes often fall into one of three categories: administration, direct care, and support.

Administration

Administrative professionals keep nursing homes running efficiently. They’re responsible for managing other employees, working with patients’ health insurance companies, and paying facility bills. Administrative positions in nursing homes include business roles such as marketing director, finance director, human resources specialist, accounts payable, and receptionist. These positions do not directly interact with residents, and some nursing homes house administrative staff in separate buildings.

Direct Care Staff

The direct care staff consists of those directly responsible for patient care. Registered nurses (RNs) represent the largest percentage of the direct care staff, as nursing homes have skilled nurses on the clock at all times working under the direction of one or more physicians. These RNs might also have nursing assistants or medical technicians assisting them. The direct care staff at nursing homes also includes therapeutic and recreational personnel, such as physical therapists, recreational therapists, activities directors, and other professionals who keep patients active and their quality of life high.

Support Staff

Support staff can include janitorial, maintenance, landscaping, and transportation personnel. These employees typically have minimal contact with facility residents but may receive specialized training on how to perform jobs in the context of a healthcare facility, as they will be among people with vulnerable medical conditions.

What Are the Benefits of Working in a Nursing Home?

Each day and night, thousands of administrators, direct care staff, and support staff wake up and head to their jobs at nursing homes. When asked, “why did you want to work in a nursing home?” many would respond that they find their careers fulfilling for a host of different reasons. From helping those in need to learning from the wisdom of seniors in their care, working in a nursing home has many benefits to offer.

Helping People in Need

Working in a nursing home means providing healthcare for people who need it. Nursing homes provide seniors with a safe, clean, healthy environment where they can receive the care they need, access proper nutrition, and experience the social benefits of being around their peers. Nursing home employees have the satisfaction of providing such care and attention, knowing they’re making a difference in the lives of their residents.

Learning About Life

Working around people in the later stages of life can teach nursing home employees valuable lessons about the aging process, the mindset of the elderly, and what it means to age. The senior members of any community have a wealth of knowledge and wisdom to share. While some fear aging, the elderly can illustrate that it’s a natural part of life and that one’s later years can be enjoyable.

Teamwork Environment

Nursing homes rely on an interdisciplinary staff to ensure operations run smoothly and provide high-quality care. As such, all nursing home employees learn what it means to work as part of a team. Each staff member at a nursing home fulfills a specific, valuable role. In most of these positions, employees work with professionals in other areas as well as with members of their own departments, thereby providing them with the opportunity to develop their communication and collaboration skills.

A Professional Future in Caring for the Elderly

There are a lot of great reasons to work in a nursing home. It means stepping into a fulfilling career in which you can provide essential care to the most senior members of your community. The U.S. Bureau of Labor Statistics (BLS) projects the healthcare field to grow by 3.3 million jobs between 2018 and 2028, making work in a nursing home environment not just rewarding but also increasingly in demand. Find out more about how Maryville University’s online bachelor’s in healthcare management with a certificate in senior living management  can help you land a great job in this important field.

Recommended Reading

A Caregiver’s Guide to Understanding, Recognizing, and Preventing Elder Abuse

Healthcare Careers

The Future of Healthcare: Trends, Technology & New Skills for Success

AARP, “What You Need to Know About Nursing Homes”

Assisted Living Today, “The Role of Nurses in a Nursing Home”

Center for Public Integrity, “Running a Five-Star Nursing Home”

Centers for Disease Control and Prevention, Nursing Home Care Statistics

Maryville University, Bachelor of Science in Healthcare Management

The Odyssey, “Why I Love Working in Nursing Homes”

Skilled Nursing Facilities, Nursing Home Staff

Thrive Global, “What I Learned from Working in a Nursing Home”

U.S. Bureau of Labor Statistics, Employment by Major Industry Sector

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The Beginner's Guide to Working in a Nursing Home

By Kristina Ericksen on 02/22/2016

Nursing homes are becoming the new normal.

By 2050, the U.S. 65+ population will double from what it was in 2012 to a staggering 83.7 million. And while many families would like to care for their aging relatives, they’re not always able to do so themselves. That’s where nursing homes come into play.

Looking forward, the aging population combined with the national nursing shortage will create an even greater demand for healthcare professionals. This means employment in a nursing home could very well be in your future.

You love caring for others, but are you really cut out for working in a nursing home? Is it that different from other nursing settings?

We spoke to seasoned nurses to see what they liked best about long-term care in a nursing home – and their answers may surprise you! Here’s what they have to say.

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What is it like working in a nursing home?

Working in a nursing home is special in that you’ll be a member of the care team collectively taking care of your residents. And because these are long-term care residents, you’ll get to know them and their conditions much better than in other types of nursing positions. Everyone works together to provide the best care for the residents.

You’ll play an important role in an interdisciplinary team, including physical therapy, occupational therapy, speech therapy, social work, case management and more. Together you’ll work on forming beneficial care plans for your patients, explains Rebecca Lee , RN.

And if you’re worried that nursing homes aren’t active and lively enough for you, think again.

“A few of our residents were bat mitzvah’d in their 80s and 90s,” shares RN Josie Vega. “Some have dementia, but revert to teenage girls and sing along when an Elvis impersonator visits. When the pet therapy dog arrives, residents talk about the puppies they once had.”

Many residents are still very proud of the lives they lived, the families they raised and the things they accomplished personally and professionally. You get to honor their legacy and contributions to society when you’re at the bedside, she adds.

What skills are needed to work in a nursing home?

Nurses in nursing homes need a different skill set than nurses in a hospital or clinic. These specialized skills allow them to concentrate their care to the needs of their residents. Hospice, rehabilitation and therapy differentiate nursing home nurses from those in more traditional settings. And they also have more involvement in the case management of their residents.

“It’s important to deliver quality care with compassion, dignity and respect,” Vega says. “A resident’s inability to see, hear or talk makes them particularly vulnerable so it’s important to notice nonverbal communication.”

But what are the most important skills you’ll need to succeed in these positions? We used real-time job analysis software to examine nearly 300,000 nurse job postings from nursing homes over the past year.* The data helped us identify the top 10 skills needed in nursing home positions.

Here is what we found:

• Patient care
• Home health
• Treatment planning
• Case management
• Patient/family education
• Medical administration
• Advanced cardiac life support (ACLS)
• Patient evaluation

What are the advantages of working in a nursing home?

As with any occupation, there are various pros and cons that come with the job. Here’s what our nurses noted as some of the perks of being a nursing home nurse:

1. You’ll get to know your patients better

“Get ready to become attached to your residents and their families,” Vega says. “They become a part of who you are and there is a special bond formed in long-term care.”

Working in a nursing home offers the opportunity to foster relationships with long-term residents more so than would be possible in an outpatient or a more traditional nursing setting.

2. You’ll sharpen your pharmacology skills

As a registered nurse, you hand out a lot of medications in nursing homes. Your pharmacology skills will improve, according to Lee.

3. You’ll work as a team

Members of the care team—including social work, therapeutic recreation, music therapy, dietary and even housekeeping—all work together for the good of the patients. This kind of camaraderie is unique and makes stressful days more enjoyable.

“The nurses are just one part of the total care package. I like that,” Vega says.

4. You’ll experience variety

You see all types of diagnoses because nursing homes are basically a generalized internal medicine unit, says Lee. This type of diversity means you’ll rarely have a boring day on the job.

5. It’s less physically demanding

Though you will be on your feet much of the day, working in a nursing home is typically less physically demanding than other options for nursing careers, according to Lee.

What are the disadvantages of working in a nursing home?

There are two sides to every coin, With the various benefits also comes a few drawbacks to working in a nursing home. Here’s what the nurses have to say:

1. You'll get attached to patients

There is a downside to establishing close relationships with your residents. You’ll inevitably develop a favorite resident or two because it’s so easy to get attached, according to Vega. Whenever a resident’s health declines, it can be heartbreaking, she adds.

2. There is a stigma about nursing homes in general

“I dislike that nursing homes get such a bad rap. People have so many negative perceptions of life at a nursing home,” Vega says.

You may work in the most wonderful nursing home in the world, but there will still be some that see it otherwise. Overcoming these misconceptions is something that you’ll likely learn to deal with on a regular basis.

3. Your skills are more concentrated

“You don't gain as much acute medical knowledge because you're working in a low-intensity environment,” Lee says.

She points out that nurses in nursing homes don’t get to practice EKGs, responding to medical codes, starting IVs, drawing cultures and blood tests, calculating medication drips or starting A-lines. So if you’re looking for an environment to help you hone those skills, a nursing home may not be your top choice.

Now you know…

Working in a nursing home is not for everyone. It takes a special person to care for the most vulnerable patients in their final years. But with the aging population, elderly patients will need your care now more than ever.

RELATED ARTICLES:

• Acute Care vs. Ambulatory Care: Which Nursing Environment is Right for You?
• Teamwork in Nursing: How to be a Key Contributor in Your Unit
• Best Day on the Job: 4 Nursing Stories that Prove it's All Worth it
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*Source: BurningGlass.com (Analysis of 296,316 nursing home nurse job postings, Feb. 1, 2015 – Jan. 31, 2016) AUTHOR'S NOTE: This article was originally published in February 2014. It has since been updated to include information relevant to 2016.

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About the author

Kristina Ericksen

Kristina is a Digital Writer at Collegis Education where she creates informative content on behalf of Rasmussen University. She is passionate about the power of education and enjoys connecting students to bright futures

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How to Write a Nursing Essay with a Quick Guide

Ever felt the blank-page panic when assigned a nursing essay? Wondering where to start or if your words will measure up to the weight of your experiences? Fear not, because today, we're here to guide you through this process.

Imagine you're at your favorite coffee spot, armed with a cup of motivation (and maybe a sneaky treat). Got it? Great! Now, let's spill the secrets on how to spin your nursing tales into words that not only get you that A+ but also tug at the heartstrings of anyone reading. We've got your back with nursing essay examples that'll be your inspiration, an outline to keep you on the right path, and more!

What Is a Nursing Essay

Let's start by dissecting the concept. A nursing essay serves as a focused exploration of a specific aspect of nursing, providing an opportunity for students to demonstrate their theoretical knowledge and its practical application in patient care settings.

Picture it as a journey through the challenges and victories of a budding nurse. These essays go beyond the classroom, tackling everything from tricky ethical dilemmas to the impact of healthcare policies on the front lines. It's not just about grades; it's about proving, 'I'm ready for the real deal.'

So, when you read or write a nursing essay, it's not just words on paper. It's like looking into the world of someone who's about to start their nursing career – someone who's really thought about the ins and outs of being a nurse. And before you kick off your nursing career, don't shy away from asking - write my essay for me - we're ready to land a professional helping hand.

How to Start a Nursing Essay

When you start writing a nursing essay, it is like gearing up for a crucial mission. Here's your quick guide from our nursing essay writing service :

Choosing Your Topic: Select a topic that sparks your interest and relates to real-world nursing challenges. Consider areas like patient care, ethical dilemmas, or the impact of technology on healthcare.

Outline Your Route : Plan your essay's journey. Create a roadmap with key points you want to cover. This keeps you on track and your essay on point.

Craft a Strong Thesis: Assuming you already know how to write a hook , kick off your writing with a surprising fact, a thought-provoking quote, or a brief anecdote. Then, state your main argument or perspective in one sentence. This thesis will serve as the compass for your essay, guiding both you and your reader through the rest of your writing.

How to Structure a Nursing Essay

Every great essay is like a well-orchestrated performance – it needs a script, a narrative that flows seamlessly, capturing the audience's attention from start to finish. In our case, this script takes the form of a well-organized structure. Let's delve into the elements that teach you how to write a nursing essay, from a mere collection of words to a compelling journey of insights.

Nursing Essay Introduction

Begin your nursing essay with a spark. Knowing how to write essay introduction effectively means sharing a real-life scenario or a striking fact related to your topic. For instance, if exploring patient care, narrate a personal experience that made a lasting impression. Then, crisply state your thesis – a clear roadmap indicating the direction your essay will take. Think of it as a teaser that leaves the reader eager to explore the insights you're about to unfold.

In the main body, dive into the heart of your essay. Each paragraph should explore a specific aspect of your topic. Back your thoughts with examples – maybe a scenario from your clinical experience, a relevant case study, or findings from credible sources. Imagine it as a puzzle coming together; each paragraph adds a piece, forming a complete picture. Keep it focused and let each idea flow naturally into the next.

Nursing Essay Conclusion

As writing a nursing essay nears the end, resist the urge to introduce new elements. Summarize your main points concisely. Remind the reader of the real-world significance of your thesis – why it matters in the broader context of nursing. Conclude with a thought-provoking statement or a call to reflection, leaving your reader with a lasting impression. It's like the final scene of a movie that leaves you thinking long after the credits roll.

Nursing Essay Outline

Before diving into the essay, craft a roadmap – your outline. This isn't a rigid skeleton but a flexible guide that ensures your ideas flow logically. Consider the following template from our research paper writing service :

Introduction

• Opening Hook: Share a brief, impactful patient care scenario.
• Relevance Statement: Explain why the chosen topic is crucial in nursing.
• Thesis: Clearly state the main argument or perspective.

Patient-Centered Care:

• Definition: Clarify what patient-centered care means in nursing.
• Personal Experience: Share a relevant encounter from clinical practice.
• Evidence: Integrate findings from reputable nursing literature.

Ethical Dilemmas in Nursing Practice

• Scenario Presentation: Describe a specific ethical challenge faced by nurses.
• Decision-Making Process: Outline steps taken to address the dilemma.
• Ethical Frameworks: Discuss any ethical theories guiding the decision.

Impact of Technology on Nursing

• Current Trends: Highlight technological advancements in nursing.
• Case Study: Share an example of technology enhancing patient care.
• Challenges and Benefits: Discuss the pros and cons of technology in nursing.
• Summary of Key Points: Recap the main ideas from each section.
• Real-world Implications: Emphasize the practical significance in nursing practice.
• Closing Thought: End with a reflective statement or call to action.

A+ in Nursing Essays Await You!

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Nursing Essay Examples

Here are the nursing Essay Examples for you to read.

Writing a Nursing Essay: Essential Tips

When it comes to crafting a stellar nursing essay, a few key strategies can elevate your work from ordinary to exceptional. Here are some valuable tips from our medical school personal statement writer :

Connect with Personal Experiences:

• Approach: Weave personal encounters seamlessly into your narrative.
• Reasoning: This not only adds authenticity to your essay but also serves as a powerful testament to your firsthand understanding of the challenges and triumphs in the nursing field.

Emphasize Critical Thinking:

• Approach: Go beyond describing situations; delve into their analysis.
• Reasoning: Nursing essays are the perfect platform to showcase your critical thinking skills – an essential attribute in making informed decisions in real-world healthcare scenarios.

Incorporate Patient Perspectives:

• Approach: Integrate patient stories or feedback into your discussion.
• Reasoning: By bringing in the human element, you demonstrate empathy and an understanding of the patient's experience, a core aspect of nursing care.

Integrate Evidence-Based Practice:

• Approach: Support your arguments with the latest evidence-based literature.
• Reasoning: Highlighting your commitment to staying informed and applying current research underscores your dedication to evidence-based practice – a cornerstone in modern nursing.

Address Ethical Considerations:

• Approach: Explicitly discuss the ethical dimensions of your topic.
• Reasoning: Nursing essays provide a platform to delve into the ethical complexities inherent in healthcare, showcasing your ability to navigate and analyze these challenges.

Balance Theory and Practice:

• Approach: Connect theoretical concepts to real-world applications.
• Reasoning: By bridging the gap between theory and practice, you illustrate your capacity to apply academic knowledge effectively in the dynamic realm of nursing.

Highlight Interdisciplinary Collaboration:

• Approach: Discuss collaborative efforts with other healthcare professionals.
• Reasoning: Acknowledging the interdisciplinary nature of healthcare underscores your understanding of the importance of teamwork – a vital aspect of successful nursing practice.

Reflect on Lessons Learned:

• Approach: Conclude with a thoughtful reflection on personal growth or lessons from your exploration.
• Reasoning: This not only provides a satisfying conclusion but also demonstrates your self-awareness and commitment to continuous improvement as a nursing professional.

As we wrap up, think of your essay as a story about your journey into nursing. It's not just about getting a grade; it's a way to share what you've been through and why you want to be a nurse.

Imagine the person reading it – maybe a teacher, a future coworker, or someone starting their nursing journey. They're trying to understand your passion and why you care about nursing.

So, when you write, remember it's more than just an assignment. It's your chance to show why nursing matters to you. And if you ever need help – there's always support from our essay writer online .

Ready to Excel in Your Nursing School Essay?

Order now and experience the expertise of our professional writers!

How to Write a Nursing Essay?

How can a nursing essay effectively address ethical considerations, what are some examples of evidence-based practices in nursing essays.

Daniel Parker

is a seasoned educational writer focusing on scholarship guidance, research papers, and various forms of academic essays including reflective and narrative essays. His expertise also extends to detailed case studies. A scholar with a background in English Literature and Education, Daniel’s work on EssayPro blog aims to support students in achieving academic excellence and securing scholarships. His hobbies include reading classic literature and participating in academic forums.

is an expert in nursing and healthcare, with a strong background in history, law, and literature. Holding advanced degrees in nursing and public health, his analytical approach and comprehensive knowledge help students navigate complex topics. On EssayPro blog, Adam provides insightful articles on everything from historical analysis to the intricacies of healthcare policies. In his downtime, he enjoys historical documentaries and volunteering at local clinics.

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Appropriate leadership in nursing home care: a narrative review

Nick zonneveld.

1 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

Carina Pittens

2 Vrije Universiteit, Athena Institute, Amsterdam, The Netherlands

Mirella Minkman

3 Tilburg University, TIAS School for Business and Society, Tilburg, The Netherlands, and Vilans, National Centre of Expertise in Long Term Care, Utrecht, The Netherlands

The purpose of this paper is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors.

Design/methodology/approach

A narrative review was performed in three steps: the establishment of scope, systematic search in five databases and assessment and analysis of the literature identified.

A total of 44 articles were included in the review. The results of the study imply that a stronger focus on leadership behaviors related to the specific context rather than leadership styles could be of added value in nursing home care.

Research limitations/implications

Only articles applicable to nursing home care were included. The definition of “nursing home care” may differ between countries. This study only focused on the academic literature. Future research should focus on strategies and methods for the translation of leadership into behavior in practice.

Practical implications

A broader and more conceptual perspective on leadership in nursing homes – in which leadership is seen as an attribute of all employees and enacted in multiple layers of the organization – could support leadership practice.

Originality/value

Leadership is considered an important element in the delivery of good quality nursing home care. This study provides insight into leadership behaviors and influencing contextual factors specifically in nursing homes.

1. Background

Leadership is seen as essential for the creation of cultural and structural change within organizations and the delivery of good quality nursing home care ( Anderson et al. , 2005 ; Martin and Learmonth, 2012 ). Various studies confirm that leadership affects e.g. business management, information flows, health-related quality indicators, long-term vision, organizational structure, organizational culture, work environment and quality of care in nursing homes ( Anderson et al. , 2005 ; Castle and Decker, 2011 ; Cummings et al. , 2010 ; Jeon et al. , 2015 ). Therefore, more insight is needed into how leadership should look to contribute to organizational and cultural change in nursing home care.

Leadership can be defined as “a process whereby individual influences a group of individuals to achieve a common goal” ( Hunt, 2004 , p. 3). Based on a review of leadership literature, Hunt (2004) distinguishes four common features of leadership. Leadership: is a process, involves influence, occurs in a group context and involves goal attainment. Leadership theory still divides leadership styles into two main groups: relationship-oriented leadership styles and task-oriented leadership styles. While relationship-oriented leadership focuses on individual persons and relationships, task-oriented leadership aims at the accomplishment of tasks. This division could also be interpreted as transformational leadership and transactional leadership ( Avolio et al. , 1999 ). Transformational leadership is reflected in a process, in which a leader connects with his/her followers, with the aim of increasing intrinsic motivation to enhance performance. The driving force is a shared vision. Transactional leadership is a more top-down style, focusing on transactions between the leader and followers. There are clear structures, rules and procedures and the extrinsic motivation of employees is addressed ( Avolio et al. , 1999 ). An example of transactional leadership is giving a personal reward for employees that achieve a certain goal, like a financial bonus. In our study, the two main streams of transformational and transactional leadership are used as an ordering framework, supplemented with a contingency approach category: context-dependent leadership styles. These styles assume that there is no universal leadership style and that different contexts and circumstances require different leadership styles ( Northouse, 2018 ).

Various publications have been written about leadership in nursing home care. In most of these studies relational and transformative-related leadership styles are considered to be most appropriate in a nursing home and aged care ( Anderson et al. , 2005 ; Corazzini et al. , 2015 ; Jeon et al. , 2015 ). The focus of most studies is the relationship between particular leadership styles and desired outcomes rather than understanding the behaviors and context behind them. However, as leadership is a process that takes place between people ( Hunt, 2004 ), it consists of many components and influencing factors. It could also take place at multiple places in an organization, both formally and informally. The relationship between how leadership is executed and the outcomes achieved are, therefore, not simple or linear ( Northouse, 2018 ). Therefore, more in-depth knowledge is required regarding leadership behaviors, the effects and the factors influencing them.

This study aims to provide a deeper understanding of what leadership is appropriate in nursing home care, also considering the changing context. To this end, various leadership behaviors, their effects and their influencing factors are examined by performing a narrative literature review with a systematic search.

The objective of this study is to synthesize the existing evidence on leadership that best matches nursing home care, with a focus on behaviors, effects and influencing factors. A narrative review with a systematic search was conducted, drawing on the principles of hermeneutic review ( Boell and Cecez-Kecmanovic, 2014 ). A hermeneutic review has two main characteristics:

• accessing and interpreting the literature and
• developing an argument.

The literature search is not only systematic but also flexible and iterative. As the identified literature increases, initial insights and ideas arise and less relevant literature could be rejected through progressive focus. It is argued elsewhere that a narrative review like a hermeneutic review should be the method of choice for interpreting a large and diverse set of literature in which authors have approached the topic differently ( Greenhalgh et al. , 2018 ), as is the objective of our literature review. The review was executed in three steps: definition of scope, systematic search and assessment and analysis of the literature identified. To structure these three steps, a search protocol was developed beforehand.

2.1. Step 1: Establishment of scope

Definition of the search area included the formulation of a set of inclusion criteria. Manuscripts were included if they:

• studied leadership;
• targeted long-term care, nursing home/facility care or elderly care and were thereby applicable to the current nursing home care context;
• behavioral characteristics of leadership;
• effects of leadership; and/or
• factors influencing leadership;
• were published between 2007 and December 2019 (because of the rapidly changing context);
• were written in English; and
• presented research findings of empirical work or reviews.

The search terms were developed through an iterative process in which three researchers were involved. Based on the two main elements of the study objectives – leadership and nursing home care – multiple search terms and combinations were explored in two databases (Pubmed/Medline and EBSCO).

2.2. Step 2: Systematic search

Using the terms described, systematic searches were performed in the PubMed/Medline, Cochrane, Cinahl, PsycInfo and Google Scholar databases. The snowballing technique was also applied: i.e. the reference lists of all articles included were studied to identify any additional relevant literature. After identifying all potentially relevant literature, assessment and analysis of the articles took place.

2.3. Step 3: Assessment and analysis of the literature identified

Assessment and analysis of the literature took place in three steps: the articles were screened based on the title, abstract and full-text to determine inclusion, data extraction took place and analysis was carried out on the articles that had been included.

• Screening on the title, abstract and full-text: All titles and abstracts were screened independently by two researchers to decide whether articles met the inclusion criteria. If the two researchers assessed the article differently, a third researcher was consulted. The full-text of the selected articles was then independently assessed for eligibility by two researchers. Again, a third researcher was consulted if there was any disagreement. For this, the principles of the hermeneutic review were applied, meaning that the inclusion of articles in a later stage (for instance, full-text screening) was stricter due to progressive insights.
• Data extraction: Two types of data were extracted from the articles. First, for each article the author(s), year of publication, journal, title, country, study design and applied methods, sector and organizational level were noted. Second, the main findings of the articles were extracted. The data extraction took place by two researchers, supervised by a third researcher. A fourth researcher was consulted if there was any disagreement.
• Analysis: Descriptive analysis was chosen, as a large and diverse set of articles was included in which leadership was approached and studied differently. As the aim was to build an understanding of leadership, the analysis focused on interpreting the findings of the articles included. Reflection on the content analysis took place with a fourth researcher.

The systematic database search resulted in the identification of 2,332 scientific articles. After removal of duplicates, 2,031 records were screened on title and abstract, based on the formulated inclusion criteria. After this screening 76 scientific articles remained for full-text assessment. During the full-text screening, 36 papers were excluded due to the following reasons: no focus on leadership ( n  =   20), not applicable to the nursing home care context ( n  =   3), leadership only focuses on external stakeholders ( n  =   2), articles report only opinions or vision ( n  =   6), no full text available ( n =  3) and no focus on the interaction between leaders and professionals ( n  =   2). As a result of the “snowballing” technique, 3 extra scientific articles were included. This resulted in a total of 44 included articles. Figure 1 shows the PRISMA flow chart, which displays the systematic literature search process. Table 1 presents the characteristics of the articles, including an overview of study design: 17 qualitative, 16 quantitative, 4 mixed methods and 7 (systematic) reviews were included.

PRISMA flow chart

Characteristics of the articles included

3.1. Leadership behaviors

The articles included in this review describe many sorts of leadership behaviors. In most articles, the studied set of leadership behaviors is given a name/title/term such as “partnered leadership,” “connective leadership” and “adaptive leadership.” In the articles, they are often connected to one of the main leadership styles. Descriptions of leadership behaviors identified are, therefore, distributed over three main categories: relationship-oriented leadership, task-oriented leadership and context-dependent leadership.

Especially more recent articles move away from leadership styles and focus more on behaviors essential for new developments in nursing homes. In the articles of Brodtkorb et al. (2019) and Backman et al. (2018) , important leadership characteristics were identified to support the implementation of person-centered care. Havig and Hollister (2018) focused on the interplay of independent workgroups (resembling self-organization) and appropriate supportive leadership.

3.1.1. Relationship-oriented leadership behavior.

In total, 15 different sorts of leaderships related to relationship-oriented leadership were identified in 34 articles. Transformational leadership was studied the most ( n  =   16), followed by relational leadership ( n  =   7) and the resonant, coaching, consensus and consultative autocratic behavioral styles ( n  =   3). Although “partnered leadership” ( Jennings et al. , 2011 ; Leutz et al. , 2010 ), “individualized consideration” ( Cummings et al. , 2010 ), “authentic leadership” ( Hakanson et al. , 2014 ) and “connective leadership” ( Jennings et al. , 2011 ) were also mentioned as research objectives, no outcomes regarding these behaviors were given in the articles.

When looking more closely at behaviors, the leadership types identified shows a lot of overlap. In relationship-oriented leadership behaviors identified, leaders focus on relationships, using emotional skills such as listening and empathy, to increase the involvement of employees ( Cummings et al. , 2008 ; Forbes-Thompson et al. , 2007 ; Havig et al. , 2011 ; Havig et al. , 2011 ; Jeon et al. , 2015 ). As Havig et al. (2011) describe: “relationship-oriented style constitutes the behaviors of supporting […], developing […] and recognizing” ( Havig et al. , 2011 , p. 2). Transformational leadership aims to create awareness and involvement of employees in line with the objectives of the organization ( Nielsen et al. , 2010 ).

3.1.2. Task-oriented leadership behaviors.

Task-oriented leadership behaviors were studied less extensively. Furthermore, they were often contrasted with relationship-oriented leadership behaviors. In total 9 task-oriented types of leadership were mentioned as study objectives in 9 of the articles included in the review. In most of the articles, no specific characteristics were described.

The similarity between task-oriented and transactional leadership behavior is that it is rational, concise and business-like. Task-oriented leadership deals with the management of tasks and activities (who does what, when and how), distribution of roles, objectives, monitoring and results ( Havig et al. , 2011 ; Havig et al. , 2011 ). Transactional leadership takes transactions between leaders and employees as a starting point ( Cummings et al. , 2010 ). In terms of behavior, this is reflected in rewarding and “punishing” employees. “Shareholder management” is characterized by behavior in which minimal attention is paid to the development of relationships between people ( Havig et al. , 2011 ). Employees work relatively autonomously, there is not much communication and decisions are made centrally. Autocratic leaders also make their own decision, but their employees face a relatively low amount of autonomy ( Castle and Decker, 2011 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ).

3.1.3. Context-dependent leadership behaviors.

Although the studies in this review focus predominantly on relationship-oriented leadership behaviors, the literature also recommends interpreting with caution. Various studies emphasize that leadership is a complex phenomenon that depends on situations and individuals ( Jennings et al. , 2011 ). Some of the articles conclude that a combination of leadership behaviors is needed. Havig et al. (2011) conclude that a combination of both relationship-oriented and task-oriented leadership behaviors is preferred in their study of job satisfaction in nursing homes ( Havig et al. , 2011 ). Nursing homes with a more hierarchical structure and more mutual interdependence could benefit from task-oriented leadership and vice versa. The authors conclude that leadership is context-dependent. Jennings et al. (2011) state:

The strongest statement that can be made based on empirical studies is that it is unwise to view transformational leadership as a preferred style, particularly when this style is assessed independently of other leadership styles and organizational variables ( Jennings et al. , 2011 , p. 15).

Some leadership behaviors identified in this review embrace this context-dependency and represent a combination of leadership behaviors. Lynch et al. (2011) describe the application of situational leadership to residential care. This is characterized by multiple behaviors of a leader, depending on the situation and the individual. Corazzini and colleagues focus on “adaptive leadership,” which makes a distinction between technical and adaptive challenges ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ). In this context, technical challenges refer to issues that can be easily defined and solved with the appropriate expertise or resources. Adaptive challenges, on the other hand, require new and innovative solutions which may also require a change in values or attitudes. Issues often include both technical and adaptive challenges, in which different leadership behaviors are needed ( Corazzini et al. , 2015 ; Corazzini and Anderson, 2013 ).

Both situational and adaptive leadership is built on the belief that appropriate leadership behaviors should be chosen based on situation and context ( Corazzini and Anderson, 2013 ; Lynch et al. , 2011 , 2018 ). Situational leaders exhibit leadership behavior, which fits with a particular situation and adapts this behavior accordingly to achieve results in a planned way. Central to adaptive leadership, which has roots in complexity theory, is the belief that there are no fixed solutions for complex issues. The behavior of adaptive leaders can, therefore, be characterized as highly flexible and adaptive, to cope with (sudden) changes and developments in complex environments ( Table 2 ).

Leadership styles and their associated characteristics and behaviors

3.2. Reported effects of leadership

In 38 articles effects of leadership were described. The effects of leadership were measured quantitatively in 15 of the articles identified. In 4 articles effects were studied using mixed-methods, in 13 articles effects were measured using qualitative methods and effects were described in 6 reviews. The described effects in the qualitative articles are less “hard” and were not taken into consideration in the table. Reported effects can be separated into five categories: the effects of leadership on:

• quality of care;
• quality of life;
• person-centered care; and
• innovation processes.

Table 3 presents the effects studied in these articles.

Reported effects of leadership

Most studies report that relationship-oriented leadership has a positive impact on employees. Relationship-oriented leadership leads to higher job satisfaction ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Havig et al. , 2011 ; Nielsen et al. , 2010 ), a better relationship with work (for example, a higher organizational commitment) ( Cummings et al. , 2010 ; Donoghue and Castle, 2009 ; Lundgren et al. , 2016 ; Nielsen et al. , 2010 ), higher productivity and effectiveness ( Buljac-Samardzic and van Woerkom, 2015 ; Cummings et al. , 2010 ) and more empowerment and development opportunities ( Cummings et al. , 2014 , 2010 ; Lundgren et al. , 2016 ; Nielsen et al. , 2008 ). Among the articles is one systematic review ( Cummings et al. , 2010 ), in which 53 articles are studied. This study concludes that relationship-oriented leadership is more likely to have positive effects on employees.

In 11 of the articles, the relationship between leadership and quality of care was studied. In these articles, different effects were observed. In four articles no effects were found ( Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Four papers conclude that relationship-oriented leadership results in a higher quality of care ( Castle and Decker, 2011 ; Harvath et al. , 2008 ; McKinney et al. , 2016 ; Westerberg and Tafvelin, 2014 ), while in one article it is concluded that a combination of task-oriented and relationship-oriented leadership leads to a higher quality of care (with the emphasis on task-oriented leadership) ( Jennings et al. , 2011 ). Based on their study in Sweden, Westerberg and Tafvelin (2014) present an indirect positive relationship between transformational leadership and quality of care, via mediating variables such as organizational support, support by experienced colleagues, workload and control ( Westerberg and Tafvelin, 2014 ). In all articles quality of care is either not defined consistently or not defined at all. One article studied the impact of leadership on quality of life in the USA. McKinney et al. (2016) report that consensus leadership behavior is “associated with a lower likelihood of deficiencies for quality of life” ( McKinney et al. , 2016 , p. 230).

Furthermore, in three articles a relationship between leadership and person-centered care is described ( Backman et al. , 2016 ; Brodtkorb et al. , 2019 ; Lynch et al. , 2011 ). Backman et al. (2016) for instance conclude that there is a significant relationship between the leadership behavior (of older managers) and person-centered care and psychosocial climate. In this Swedish study, the most appropriate type of leadership and the associated behavior is not specified. Concerning the implementation of person-centered care, Backman et al. (2016) mention “Person-centered care moderates the relationship between leadership behavior” ( Backman et al. , 2016 , p. 8). The authors conclude that leadership is more important in organizations that offer less person-centered care. In these organizations, leaders need to provide direction toward a more person-centered way of working. In line with this, Brodtkorb et al. (2019) revealed: “a close connection between leadership style [participative leadership] and culture change processes toward PCC” ( Brodtkorb et al. , 2019 , p. 134).

On the other hand, a number of studies present contrasting findings or caveats (weak or even no evidence) with respect to the positive effects of relationship-oriented leadership ( Harvath et al. , 2008 ; Havig et al. , 2011 ; Jennings et al. , 2011 ; Jeon et al. , 2015 ; Marotta, 2010 ; Olinger, 2010 ). In a Norwegian study, Havig et al. (2011) report that task-oriented leadership has a more significant impact on the job satisfaction of employees. Also, Jennings et al. (2011) conclude that there is little empirical evidence to relate impacts to certain leadership because leadership is multidimensional and complex: leaders use combinations of leadership behaviors and styles in practice. Olinger (2010) found no statistical significance for nursing home administrator and nursing director leadership styles on care quality.

3.3. Factors influencing leadership

Out of all articles included in this review, 22 articles describe factors that could influence leadership. The influencing factors were identified at three levels: the leader, the team(s) and the organization. Table 4 presents these factors.

Factors influencing leadership

A number of influencing factors – found in seven articles – can be related to the leader him/herself: personal characteristics of the leader ( Cummings et al. , 2008 , 2014 ; Nielsen and Cleal, 2011 ), leadership competencies ( Cummings et al. , 2008 ), educational activities ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ) and distance to practice ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). The systematic review by Cummings et al. (2008) provides particular insight into the influence of these factors on relational leadership. Cummings et al. state that the personal characteristics of effective leaders relate to openness, extraversion and management motivation. “Significant positive relationships were reported between the leaders’ motivation and their leadership behaviors.” ( Cummings et al. , 2008 , p. 244). Education of leaders, both in relation to professional knowledge and to leadership skills, is mentioned as a positive influencing factor in three articles ( Cummings et al. , 2008 ; Hakanson et al. , 2014 ; Vesterinen et al. , 2009 ). In a Swedish case study, Hakanson et al. (2014) found that leaders identify their own shortcomings and needs for personal development by following educational activities. The specific content of the different educational activities or programs were not described in the articles. A distance to practice was found to be a constraining factor ( Havig and Hollister, 2018 ; Kristiansen et al. , 2016 ). As illustrated by Havig and Hollister (2018) :

They also spent less time at the ward and did not have the same knowledge about their employees’ work situation as the leaders in the high-quality wards. The result of this lack of leadership was often poor work environments, with interpersonal conflicts and frustration, which distracted the care workers and turned their focus away from their daily work duties and the residents ( Havig and Hollister, 2018 , p. 379).

Ten studies showed that team-related factors could influence leadership:

• turnover and absence ( Cloutier et al. , 2016 ; Havig et al. , 2011 );
• interpersonal relations ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 );
• workload ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 );
• willingness to be coached ( Cummings et al. , 2014 ; Havig et al. , 2011 );
• employee well-being and satisfaction ( Cummings et al. , 2014 ; Nielsen et al. , 2008 );
• self-efficacy ( Nielsen et al. , 2009 ; Nielsen and Munir, 2009 ); and
• interdependent workgroups ( Havig and Hollister, 2018 ).

Two articles relate a high turnover and/or absence rate of employees to less effective leadership ( Cloutier et al. , 2016 ; Havig et al. , 2011 ). In a Western Canadian case study, Cloutier et al. (2016) report that “With greater staff mobility and change, the leadership had less knowledge of their staff to mobilize existing skill sets, use the expertise and build cohesion” ( Cloutier et al. , 2016 , p. 12). Close interpersonal relations – staff/staff, leader/staff and staff/resident – were found to be positively related to leadership ( Corazzini et al. , 2015 ; Havig and Hollister, 2018 ). In turn, a high workload was negatively related ( Corazzini et al. , 2015 ; Westerberg and Tafvelin, 2014 ). Also, the (un)willingness of teams to be coached was mentioned as an influencing factor ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Cummings et al. illustrate this as follows:

“Some managers reported out that some of their staff have little interest in learning new things and updating their skills and knowledge,” as per the following quote: “They just want to do their job and go home.” […] A manager, who considered coaching uninterested staff to be undesirable, reported: “Not wanting to rock the boat (don’t have time to risk losing that staff)” ( Cummings et al. , 2014 , p. 205).

Furthermore, employee well-being and satisfaction were stated as potential influencers of leadership. Although there is limited evidence of the direct relationship between leadership behavior and well-being ( Nielsen et al. , 2008 ), two articles mention that a higher level of job satisfaction corresponds to more effective leadership ( Cummings et al. , 2014 ; Nielsen et al. , 2008 ). Finally, Havig and Hollister (2018) found that independent workgroups (or teams) of caregivers, which had their own meetings, reports and administrator, could have a possible influence on nursing home quality. Their analysis revealed that workgroups were fostered by three mediators, namely, psychological ownership, perceived insider status and shared mental models.

In total, 20 articles described factors that influence leadership at an organizational level. The following factors were identified in this category:

• organizational structure ( Corazzini et al. , 2015 ; Cummings et al. , 2008 , 2014 ; Lundgren et al. , 2016 ; Rokstad et al. , 2015 );
• the extent to which person-centered care has been implemented ( Backman et al. , 2016 , 2020 );
• organizational culture ( Ali and Terry, 2017 ; Backman et al. , 2020 ; Corazzini et al. , 2015 ; Havig and Hollister, 2018 ; Jeon et al. , 2010 ; Nielsen et al. , 2008 ; Vesterinen et al. , 2009 );
• the available information and information flow ( Forbes-Thompson et al. , 2007 ; Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Vesterinen et al. , 2009 );
• previous leaders ( Vesterinen et al. , 2009 );
• available budget and time ( Ali and Terry, 2017 ; Cummings et al. , 2014 ; Hakanson et al. , 2014 ; Nielsen et al. , 2010 ; Rokstad et al. , 2015 );
• tasks and responsibilities ( Hakanson et al. , 2014 ; Jeon et al. , 2010 ; Kristiansen et al. , 2016 ; Nielsen et al. , 2008 );
• the leadership team ( Hakanson et al. , 2014 ; Vesterinen et al. , 2009 );
• organizational dynamics and stability ( Jeon et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 );
• support from superiors ( Jeon et al. , 2010 ; Westerberg and Tafvelin, 2014 ); and
• openness to change and innovations ( Brodtkorb et al. , 2019 ; Jeon et al. , 2010 ; Lynch et al. , 2011 ; Nielsen et al. , 2008 ).

First, the structure of an organization was found to influence the way in which leadership is performed. In bigger organizations, for instance, there is often more distance between managers and the work floor than in smaller organizations and this creates challenges to performing direct, relational leadership ( Lundgren et al. , 2016 ; Rokstad et al. , 2015 ). As Lundgren et al. state:

Physical distance between leaders and subordinates reduces the opportunity for leaders to supervise, organize and optimize nursing assistants’ work situations, which may have negative effects in the field of home help services ( Lundgren et al. , 2016 , p. 51).

In a Finnish qualitative study, Vesterinen et al. (2009) report that organizational culture and information available for employees influence leadership:

The managers said that their leadership style was influenced by the flow of information in the organization. It was difficult to lead others toward a vision when there was a lack of information ( Vesterinen et al. , 2009 , p. 508).

Other influencing factors include tasks and responsibilities of leaders ( Hakanson et al. , 2014 ; Kristiansen et al. , 2016 ) and available budget and time. Although they emphasize that leadership depends on situations and people, Nielsen and Cleal (2011) relate a stable organization (low staff turnover, financially stable, no reorganizations) positively to (transformational) leadership.

4. Discussion

As a result of analysis of the academic literature currently available, the findings of this study provide insight into leadership behaviors, their effects and factors influencing them. When looking into what kind of leadership is considered appropriate in the nursing home care context, also considering its current developments, our analysis does not provide an unambiguous answer. Our review shows that leadership in nursing home care is a complex and multidimensional undertaking, influenced by multiple internal and external factors. On the one hand, there is a tendency toward relationship-oriented and transformational leadership in particular. Our search identified 15 different sorts of leadership related to relational leadership with many reported positive effects on health-care professionals, quality of care, quality of life and person-centered care. However, a diversity of measures was used, with a variety in quality. Both quantitatively and qualitatively observed effects were considered. On the other hand, contrasting findings have also been reported, for example, both positive and negative effects on job satisfaction associated with task-oriented leadership ( Cummings et al. , 2010 ; Havig et al. , 2011 ). Also, various studies emphasized that “good” leadership cannot be achieved by applying only one type of leadership behavior. Both relationship-oriented and task-oriented leadership have resulted in positive effects, as demonstrated by the evaluation of job satisfaction in nursing homes ( Havig et al. , 2011 ). Furthermore, as a broad scope was used to comprehensively identify insights applicable in nursing home care, the studies compared in this review were carried out in different contexts (for example, nursing homes, long-term care, facility care, etc.) in different countries using different methodologies. For example, in the studies included in which a relationship between leadership and quality of care was reported, different definitions of quality of care were used and there was no differentiation between specific aspects of quality of care ( Castle and Decker, 2011 ; Havig et al. , 2011 ; Marotta, 2010 ; McKinney et al. , 2016 ; Olinger, 2010 ; Westerberg and Tafvelin, 2014 ). Therefore, it is also difficult to interpret and compare the results of these studies. This makes it hard to draw any meaningful conclusions about the effects of certain leadership. Another complicating factor in the identification of appropriate leadership is that leadership is a product of multiple influencing factors. Our review identified 22 influencing factors at the individual, team and organizational levels. This shows that leadership in nursing home care is not only complex and multidimensional but may also be influenced by internal and external factors. As a consequence, when looking for appropriate leadership, the answer does not lie in one type of leadership.

This observation is also reflected in some of the articles included in the review. Although a relationship-oriented style was the basis for investigation in most of the studies analyzed, some of them report that certain contexts and situations demand more task-oriented behaviors. Furthermore, literature also shows that the combination of both styles may be appropriate. A balanced mix of leadership styles, for instance, a relationship-oriented focus combined with task-oriented behaviors, is also advocated in other sectors outside nursing home care. Mintzberg (2009) , for example, cites the broad variety of leadership styles in the literature and emphasizes that the application of one style may lead to management that is not in balance ( Mintzberg, 2009 ). Furthermore, in their study on leadership patterns and their effects on employee satisfaction and commitment, Gavan O’Shea et al. (2009) conclude that effective leaders use a combination of styles ( Gavan O’Shea et al. , 2009 ). This was also the conclusion reached by Aarons (2006) specifically with respect to the mental health sector ( Aarons, 2006 ).

While our analysis shows a tendency in favor of combinations of elements from different types of leadership to deal with different situations and contexts, many included studies explore relationships between relational and task-oriented leadership only in a bivariate way. As Cummings et al. (2010) conclude:

In our analyzes, we had simplified the pattern of two approaches to leadership styles and their impact on specific outcomes for nurses, the nursing environment and the nursing workforce. In reality, leadership practices, behaviors and styles and outcomes are not that clean-cut ( Cummings et al. , 2010 , p. 17).

This awareness demonstrates that a greater focus on leadership behaviors in relation to contextual factors rather than leadership styles could provide more valuable insight into appropriate leadership in nursing home care. In most of the literature reviewed, however, leadership behavior is not described or explained precisely. Fortunately, more recent literature is moving away from studying solely leadership styles and is focusing more on appropriate leadership behavior for new developments, like the implementation of Dementia Care Mapping and person-centered care ( Backman et al. , 2020 ; Lynch et al. , 2018 ; Quasdorf and Bartholomeyczik, 2019 ).

Another point worthy of reflection is that the results of our study show a broad variety of leadership terms, styles and names and a large degree of overlap between their characteristics. This is especially the case in the field of relationship-oriented leadership. It is debatable whether these different definitions of leadership really encompass different behaviors or only use different terminology.

Considering that a focus on leadership behaviors could provide more insight into effective leadership in nursing home care, it is interesting to ask what leadership behaviors will be appropriate with respect to the current developments in nursing home care. First of all, the nursing home care sector could be considered as a complex adaptive system (CAS), in which the connected elements of the system evolve and adapt continuously ( Meadows, 2008 ). The current developments, with tendencies toward decentralization, self-organization and person-centered care, are examples of this evolving and adapting system. While the nursing home care sector consists of many different entities and a high level of interactivity, nursing homes can also be considered as systems in which organizational dynamics take place ( Ashmos et al. , 2000 ). The consequence of leadership behavior is that it is important to be aware that employees are part of a complex system, both in the organization and in the health system as a whole. As complexity scientists ( Lichtenstein et al. , 2006 ) reflect: “leadership is a dynamic that transcends the capabilities of individuals alone; it is the product of interaction, tension and exchange rules governing changes in perceptions and understanding.” ( Lichtenstein et al. , 2006 , p. 2). In this complex environment, it is important to reflect continuously and analyze the suitability of leadership behaviors in different contexts and situations. Corazzini et al. (2015) elaborate on this in their study about adaptive leadership and they conclude that problems in nursing homes are mostly complex and cannot be solved by one type of leader.

Furthermore, current developments toward flat organizations, decentralization and self-direction, show a tendency toward more collective responsibility and ownership at all layers of organizations. Most papers included in this review addressed a specific organizational level. A number of studies focus on leadership in middle management ( Buljac-Samardzic and van Woerkom, 2015 ; Corazzini and Anderson, 2013 ; Hakanson et al. , 2014 ; Leutz et al. , 2010 ; Nielsen et al. , 2010 ; Nielsen and Cleal, 2011 ; Oldenhof et al. , 2016 ; Vesterinen et al. , 2009 ) and only one article is specifically taking independent workgroups (teams) into account ( Havig and Hollister, 2018 ). Other articles cover board/management level and some do not focus on a specific organizational level. In the light of current developments in nursing home care, taking new organizational structures with decentralized collective responsibilities such as self-directed teams, into account, a focus on leadership across multiple layers of nursing homes would provide more detailed insights into leadership behaviors and the complex interaction between people and situations. It is striking that the current review did only identify one article that focused specifically on these issues.

4.1. Research limitations and implications

The literature review was carried out in a structured and systematic way. Six systematic reviews were used in this study, which included 255 articles in total (including several studies published before January 1, 2007). This provided a strong theoretical basis, including insights into a broader context. Because the leadership literature is extensive, only articles applicable to nursing home care were included. On the one hand, the current tendencies and insights in leadership literature are well represented in the literature applicable to nursing home care. On the other hand, the leadership literature in this sector is still relatively new. This may yield articles that take an exploratory approach. Also, the definition of “nursing home care” may differ between countries as will the services or care which are captured under this term. Furthermore, relevant insights in nursing home care are often shared in non-academic documents or grey literature. This study only focused on the academic literature. This “publication delay” could explain that literature on relatively new leadership-related tendencies such as self-organization, self-management and autonomous teams, was not available.

The results of this study show that a broad range of leadership behaviors is evident in nursing home care. Further investigation of behaviors that match particular contexts or situations would be relevant. The behaviors identified in this review provide insight into leadership in nursing home care, but more research is needed on how this is reflected in practice. Characteristics such as involvement and appreciation mainly focus on the result of leadership behavior, while more knowledge could be gained about how to actually achieve this. Future research should focus on strategies and methods for the translation of leadership into behavior in practice. Another relevant avenue of research is the impact of cultural aspects on leadership. Research demonstrates that leadership-related culture and values may differ across settings and countries ( Ardichvili and Kuchinke, 2002 ; Chhokar et al. , 2007 ; Hofstede, 2011 ). Examples are power distance, masculinity, uncertainty avoidance and long-term orientation ( Hofstede, 2011 ). These core values could influence leadership approaches and behaviors in practice. Our review includes studies from various, mainly Western, countries such as the USA, Canada, Australia, England and multiple Scandinavian countries. The included articles do not explicitly reflect on the cultural aspects of leadership. More insight into what the exact impact of these aspects is would be relevant. Finally, an interesting research question would be to compare how leadership behavior is perceived by the different people involved. The role of informal leadership and the dynamics in collaborating networks could also be interesting topics for further research.

5. Conclusions

In conclusion, because leadership in nursing home care is multidimensional and influenced by multiple factors, no specific type of leadership can be considered as most appropriate. Furthermore, this review showed a high level of overlap between the behaviors of the many types of leadership presented in the articles included. It is, therefore, questionable whether leadership styles are a useful vocabulary in the debate on leadership in nursing homes. Moreover, the current tendency toward flat organizations, decentralization and self-direction transforms leadership into a more collective undertaking that transcends hierarchy and encompasses behavior, context and people. Tendencies toward networks of collaborating organizations require new leadership competencies that transcend organizational boundaries and interests. Therefore, a stronger focus on leadership behaviors in relationship to specific contexts instead of the application of leadership styles could provide more insight into what is needed when and what works.

The findings of this study show that leadership is a complex and multidimensional phenomenon, which is determined by multiple internal and external factors. Employees of nursing homes have to be aware that the success of leadership is determined by the interplay between behavior and several contextual factors and the various people involved. Furthermore, the study findings suggest focusing more on leadership behaviors instead of styles. Although thinking in leadership styles could be helpful in terms of categorization and framing, a broader and more conceptual perspective on leadership could be helpful in providing more insight into the underlying mechanisms and behaviors that play a role in leadership. First, a broader perspective implies that leadership should be seen as more than merely a function for managers and team leaders ( Martin and Learmonth, 2012 ). It should be constructed as something to be enacted by all employees across an organization. Second, the broader perspective also means that one has to be aware that leadership processes take place at multiple layers in an organization, e.g. in the care setting, in professional interaction or at the board level. Third, people in organizations could benefit from more awareness of their leadership behavior and how this fits with the current context, circumstances and developments.

Acknowledgments

Funding : The research is funded by the Dutch Ministry of Health as part of the W&T Program. The Ministry of Health had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript.

Competing interests : The authors declare that they have no competing interests.

Availability of data and materials: The data sets used during the current study are available on request.

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Home — Essay Samples — Nursing & Health — Nursing Practice — My Nursing Experience: A Journey of Growth and Learning

My Nursing Experience: a Journey of Growth and Learning

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The power of compassion: a key lesson in nursing, advocacy: a role beyond patient care, embracing lifelong learning: a nursing imperative, conclusion: a journey of growth and exploration.

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Why I Love Being a Nurse

May 9, 2016 | Blog , Health & Wellness

On a daily basis, nurses do so much for so many. Whether they’re helping patients, comforting families, teaching students, or working with hospital administrators, their days are often packed.

No matter where you work or what type of nursing work you do, it all contributes to make a difference. Thank you for everything! If you want to personally thank a nurse who made a difference in your life, join in on Twitter with the hashtag: #ThankANurse.

“I am a Family Nurse Practitioner of 16 years, and was an RN prior to that. My joy is caring for my patients, and the trust that develops with that relationship. They fulfill me, and I help provide them with the care they deserve.” —Kathrine Hardy, FNP, RN, Primary Care Associates, Anchorage, Alaska

“I love being a nurse for many reasons—mostly because it has brought me into the lives of people whom I wouldn’t have met if I weren’t a nurse. Some of the most interesting people I have ever met came into my life because I’m a nurse.” —Lana Miller Davidson, RN, Public Health Nurse, Baltimore County Health Department, Baltimore, Maryland

“There is a tangible satisfaction in helping others achieve goals, whether it be in health promotion or nursing education. Having an influence on patients, students, and the community is the greatest reward in nursing.” —Lori Wilt, PhD, RN, NJ-CSN, NCSN, CNE, Assistant Professor of Nursing in the Undergraduate Department, Seton Hall University College of Nursing, South Orange, New Jersey

“My passion for nursing stems from being influenced by two incredible historical leaders— Clara Barton and Mother Theresa. Neither are traditional nurses by occupation, but both spent their lives serving people in times of hardship, loss, and devastation. Their example has inspired me to love nursing by making a difference in the lives of others. The early foundation of Clara Barton’s vision and the compassion and selfless service of Mother Theresa have been constant reminders throughout my nursing career of what really matters. Despite the challenges, it is a calling and a love unending.” —Pam Colvin, MSN, RN, CEN, Nurse Manager, Legacy ER & Urgent Care, Coppell, Texas

Veena Baksh

“I like nursing because it’s a profession that never stops giving. You learn new things every day, and the opportunity for growth is almost unlimited. I feel so good inside when I see improvement in my patients and also when giving emotional support by holding hands of family members who have just experienced tragedy. Actually, it gives me inner peace that I was able to help somebody.

My mom told me every time you have patients and family members and they feel better, count that as a blessing. I’m still counting my blessings every day, and–guess what?—I’m getting paid for that. I thank God every day for this opportunity I have been given.” —Veena Baksh, BSN, CCRN, Neurosurgical Intensive Care Unit, North Shore University Hospital, Manhasset, New York

“For me nursing is the most rewarding, diverse, and flexible career. There are numerous opportunities to expand your career in a wide variety of venues. I choose critical care nursing for most of my career. As a critical care nurse I worked very closely with all members of the health care team to provide my clients and their significant others with excellent evidence-based nursing care. I was able to coordinate all care provided by the entire health care team.  Relationships were fostered with clients and their significant others, and I enjoyed the opportunity to support them in times of joy, as well as times of sadness.

After working as a critical care nurse, I changed my focus and became a Nurse Educator . I now enjoy a career as a professor of nursing in a baccalaureate nursing program. I continue to use my nursing skills as a teacher; however, my focus is now on helping to shape the future of the nursing profession.” —Lisa Sparacino, PhD, RN, CNE, Assistant Professor of Nursing, NYIT School of Health Professions, Old Westbury, New York

Alicia Schwartz

“The reason I love being a nurse is because it is so rewarding to make a difference in someone’s life. It’s beautiful when you look into a patient’s eyes and see the window to their soul–when just a caring touch or word can make a connection. I love being able to establish a relationship based on trust that lets me guide my patients to better health.” —Alicia Schwartz, MSN-ED, PCC, RN CCM, Registered Nurse and Care Coordinator for VNSNY CHOICE Health Plans, New York, New York

“All of the hard work that nurses put forth on a daily basis is all made completely worthwhile when you see a patient who once needed constant care regain their independence. I love my job as an in-home care nurse specifically because it encourages me to keep my skills sharp and think outside the box to handle the situation at hand. It’s just you and the client in the room and there is no one there to serve as a resource. Above all, I am passionate about improving the quality of life for all of my clients and that is a constant validator that I am in the right profession. It’s not a career to me, it’s a calling.” —Vashti Johnson, RN, BSN, Director of Nursing for BrightStar Care, Cary, North Carolina

Denise Chicoine

“I am passionate about healthy living, education, and caring for others, but improving the lives of patients is at the core of why I became a nurse. I specialize in caring for people living with multiple sclerosis (MS). MS is a chronic disease with unpredictable symptoms, which can have both a physical and emotional burden. For me, caring for someone means addressing these emotional as well as physical symptoms.

Through my work, I am able to connect directly to people living with MS and their care partners, learning about their specific cases, and offering support and tools needed to manage their disease. The opportunity to work so closely with people living with MS allows me to build connections and get to know patients on a personal level—these are the experiences that remind me of the reasons why I love being a nurse.” —Denise Chicoine, RN, MS, MSCN, Telehealth Nurse Educator , MS One to One, a patient support program by Sanofi Genzyme

Lillian Costa

“I love nursing because it allows me to get close to people unlike any other profession. During a trying time in my life, I had a wonderful experience with a nurse that inspired me to change my profession and go into nursing. Each and every time I have a special moment with one of my patients, I’m able to reflect on the moments I had with my late husband.” —Lillian Costa, RN, Progressive Care Unit, Englewood Community Hospital, Englewood, Florida

“One of the things I find most rewarding about being a home care nurse is when I pass someone on the street, or see them out and about after I’ve cared for them. Sometimes they don’t even see me, but I can see how well they’re doing and how well they’ve recovered from an illness or surgery.

I’ve lived and worked as a nurse in the same community for about 20 years now, so I often see the people I care for as they recover. It’s great when someone pulls me over on the street to tell me how they’re doing, even when it’s been a while since I’ve seen them. It’s that ‘Hey John, I’m cancer free!’ that really makes my day and helps me know that what we do as home care nurses really does make a difference.” —John Ramos, RN, Home Care Nurse, Visiting Nurse Service of New York, New York, New York

Linda D’Antonio

“I love nursing because when you pull the curtain, it’s just you and your patient. It transcends time and history, and I feel the same caring and love as Florence Nightingale, Clara Barton, and the millions of others who have the calling to serve as nurses.” —Linda D’Antonio, MSN, RN, Senior Faculty Associate, Undergraduate Department, Seton Hall University College of Nursing, South Orange, New Jersey

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Work Experience Diary of a Health Care Assistant Essay

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Day 1: Assisting a Client with Swallowing Difficulties

Day 2: dealing with challenging behaviors, day 3: communicating with a client with sensory difficulties, day 4: bathing a client who has mobility problems, day 5: dressing a client with dementia, day 6: transferring a client from bed to wheelchair, day 7: recreational activities – one day example and description of the activity, reference list, description of immediate setting.

I work in a nursing home center, which has 140 residents. As a health care assistant, I provide care to residents with their daily routines. Patients treat me well, gratefully accept help and listen to my advice. Given the individual health issues of each resident, they may face some challenges in activities that seem a simple and integral part of life for younger people. As of now, given the COVID-19 guidelines on nursing care capacity, 100 spots out of 140 are occupied. The patient-to-staff ratio is approximately four patients per employee. For example, on the first day, I worked with Mrs. Jones, 79, who has lived in a nursing home for three years. She developed good habits and daily routines and has many friends. Mrs. Jones does not have and has not had in the past addictions or serious health problems. She has type-2 diabetes, which is very typical for her age, and joint pain is being cured. For the first three years at the nursing home, Mrs. Jones had no issues with mobility and performing general activities of daily living (ADLs), asking for assistance only when she did not feel well. However, currently, every day, she requires more help with performing her daily routine and has a higher dependence level.

Routine of the Care Setting

As seen from the schedule above, my primary task is to assist the patients throughout their routine, paying specific attention to feeding and taking care of Mrs. Jones. As far as the activities for the day are concerned, I am assigned to reading, movie club, and the preparation for the quiz night.

Daily Living Tasks

Recently, Mrs. Jones has been experiencing swallowing difficulties and now needs assistance with feeding. Therefore, as her assistant, I took it upon myself to make sure she was eating well. So, during breakfast, lunch, and dinner, I follow a similar procedure:

• I greet Mrs. Jones, and I ask her if she is hungry right now;
• I help her sit and bring the food closer to her
• I make sure Mrs. Jones sits upright, chews well, and takes small pieces.
• I make sure that Mrs. Jones is careful, rinses their mouth after eating, and stays upright (sitting) for 30-60 minutes to avoid the possible ingress of food debris into the lungs.
• I can sometimes ask the patient to cough, as the lungs are protected from aspiration by coughing and vomiting reflexes.
• From time to time, I ask Mrs. Jones whether she wants more, and I feed her until she says it is enough;
• I help her clean up, check on her aspiration and whether she has anything stuck or bothering her;
• I clean up and escort her to others or her room.

The doctor has some guesses about the cause of the problem and is preparing a treatment plan for Mrs. John while I help her deal with the symptoms.

Communication with Stakeholders

Family members do not visit Miss Jones very often, but they are aware of her health. In addition, at the last meeting, the doctor had an in-depth conversation with Mrs. Jones and her daughter, and this conversation took place in my presence. I also assured Mrs. Jones’ daughter that I would take the best care of Mrs. Jones and inform her if necessary and about the process of treatment and recovery after stroke. Mrs. Jones’ daughter asked many questions about the causes and complications of post-stroke conditions, and the doctor was able to answer most of them, so she left our facility calm and satisfied with the service.

Challenges and Rewarding Aspects

The experience of communicating and caring for Mrs. Jones was very useful to me as I learned not to be afraid of difficult situations and realized that timely treatment and care to guide the treatment in most cases minimizes risks and results in complete recovery of the client. Mrs. Jones is an optimistic woman, and she helps me take care of her and tries to keep her calm and optimistic, which is very important for her recovery. Therefore, this experience gave me more confidence in my professional abilities and made me feel that my support is appreciated. The only challenge, however, concerned the specifics of communication with the patient who suddenly feels helpless. Since Mrs. Jones was used to being a self-sufficient woman, she now finds it extremely hard to seek assistance. Hence, I found it challenging to help her without making her feel miserable even though she did not show her emotions and seemed rather calm about the situation.

As I have already explained, I work in a nursing care center where more than 140 people live and receive support. Currently, however, the capacity of the nursing home remains at nearly 100 patients with an error margin of ~ two patients who could be discharged from the facility for a few days due to family circumstances. The staff to patient ratio remains satisfactory, as more than 20 staff nurses are working with the patients. On day two, I worked with a patient named Mark, a 75-year-old man with a history of alcohol abuse.

Routine of Care Setting

During the day, my primary task is to assist Mark with the activities during the day and make sure he behaves well and socializes with other home residents.

Mark is 75, and all his life, he worked hard, had his own business, which now employs his nephew, and a good fortune. Mark has good prospects for recovery, but his mood is constantly changing due to the loss of the opportunity to work, and he does not have a metaphorical anchor that would allow him to feel part of the world, to feel needed. Mark sometimes feels that the staff is hostile to him, and the ban on alcohol was a difficult test in the first few weeks of his stay in the institution. Therefore, he could behave irritably or aggressively and be hostile to the staff who seized alcohol from him, as well as to other patients who seemed to condemn him.

One of the primary concerns when working with Mark is his inability to find common ground with the other residents. To address this issue, on day two, I place emphasis on encouraging Mark to take part in group activities:

• During breakfast, I come to Mark and carefully ask him about his plans for the day;
• If he is in a bad mood, I suggest he talks to me in private about what is bothering him; If he responds calmly, I suggest we take a look at today’s schedule and find an activity for him to enjoy;
• Once we choose an activity, together, we proceed to the game club to play cards;
• I gently suggest he join the group, and I ask him whether he would feel more comfortable if I were at the table too;
• We make an agreement that if he feels uncomfortable or angry all of a sudden, instead of yelling at the group, he comes to me and tells me why he feels irritated and angry;
• If needed, we seek counseling immediately after.

When taking care of Mark, I make sure to maintain constant communication with the medical staff to improve his condition. I frequently collaborate with the therapist and physiotherapist to make sure that Mark receives the treatment he needs in order to minimize the irritable triggers to his anger issues and the risk of relapse. However, the most important communication takes place with the local clinical psychologist, as she provides me with explicit advice on how to talk to Mark when he is on the verge of violent and isolative behavior. Mark does not communicate with his family due to his past issues, and the only visitor he has is his 35-year-old nephew Aaron. I try to reach out to him and ask him to come for a visit once in a while when Mark feels especially lonely.

Challenging and Rewarding Aspects

Undeniably, Mark is an extremely challenging patient whose violent behavior and lack of interest in life make it hard for the nurses to take proper care of him. However, when exhibiting such behavior, Mark helps me explore new ways of connecting to reserved patients. While talking to Mark, I am interested in his life, and he often tells funny stories. He is happy when his sons visit him, and I try to keep them motivated. When answering the sons’ questions, I describe the positive changes in Mark’s well-being and how his psychological state stabilizes. He receives the grateful views of his sons and their support during these conversations. Mark is used to living a social life, but it was difficult for him to make friends. Over time, he became less suspicious and demonstrated improved socialization skills. Working and communicating with Mark gave me a better understanding of the problems of other patients at the facility.

Currently, our facility has nearly 100 residents and accepts people with visual or hearing impairments. Our health professionals have developed unique programs to work with sensory difficulties. However, our institution does not have a sufficiently adapted leisure system, and people with sensory difficulties may feel excluded from the communicative process. On day three, I am assigned to assist Leila, a 73-year-old woman with hearing impairment. The challenge during this day is also caused by the fact that three nurses could not come to work due to health issues.

On day three, my primary task is to make sure that Leila feels more included in the activities planned out for the day:

Leila, 73, has a hearing impairment of medium severity, she reads on the lips, and I have to follow certain rules of communication for her comfort. Leila lives according to the same schedule as the other residents: she has breakfast at 9:00, then she takes a bath, at 11:00, Leila drinks tea with cookies and relaxes in her room. Later, she goes for a walk, has lunch from 13:00 to 14:00, and exercises in the evening. Leila does not participate in team games, but she has friends who also have sensory difficulties, so she does not feel lonely.

Every few days, I measure the pressure for Leila and can talk to her at this time. When communicating with Leila, I make sure she sees my face, and I sometimes use sign language for word-by-word indexing. I also speak clearly, do not raise my voice, do not cover my mouth, and allow Leila to ask questions either in sign language or by writing questions in a notebook when I can’t understand the question. During my first meeting with Leila, I asked her to invite an SL interpreter, explaining that I had not mastered sign language. However, Leila refused and assured me that I could learn quickly.

On this particular day, we have an evening activity of a mini-improv show where the residents can show off their talents, and I want to encourage Leila to participate in the show. In the morning, before tea and biscuits, I come to Leila’s room to help her dress and wash. I say “Hello,” and after she responds, I do the following tasks:

• I ask whether she needs any help with dressing and washing, making sure she is able to read my lips;
• I help Leila come to the toilet and wait for her outside in case she needs any help;
• I ask Leila if she has any plans of attending tonight’s show and whether she wants to participate;
• I suggest Leila performs one of her favorite poems in sign language, whereas I can help others understand the content by reciting the poem;
• I know that Leila loves Byron’s poems, so I hand her an anthology of his most famous poems for her to choose.
• I make sure Leila understands me by using sign language and notes, if necessary;
• I escort Leila to the recreational area to have some tea and cookies;
• I go with Leila to watch some TV, helping her understand the content in case she does not see the speaker’s lips or has some issues understanding the speaker.

I always reach out to Leila’s children in order to inform them of her well-being and the things she needs them to bring. The communication usually happens once a week, as they come to visit her on the weekend. I communicate with her therapist every day in order to modify or enhance the treatment course based on her well-being and concerns. I also make sure to communicate with other nurses during the shift handover to be up to date with Leila’s health status and emotional state.

It is interesting for me to communicate with Leila – she has a polite and positive attitude towards me. She has lived in the institution for four years and is visited every month by her daughter, who brings Leila sweets and other gifts. Leila and her daughter communicate in sign language very skillfully. When I talk to Leila’s daughter, I make sure Leila sees my face well, which is very important in group communication. In general, Leila makes a very positive impression on me, as she treats people very well. However, I feel discomfort because I do not speak sign language at a high level, so I do not give up my exercises. I have an idea to invite a trainer to conduct weekly training for healthcare assistants, as 23 people with sensory difficulties live in our institution.

Our nursing home facility has a successful architectural design with well-thought-out logistics for people with mobility problems, including soft floors, handrails in corridors, and transitions from vital areas such as the dining room, recreation area, and residential zones. We have bathrooms specially designed for people with mobility problems. The 35 residents of our institution have some types of mobility problems and need special attention to meet their needs. Considering the staff to patient ratio of an average of 5 patients per nurse, approximately two of my everyday patients struggle with mobility and autonomy in general.

Today, my primary goal is to help Jane, an 85-year-old patient with mobility issues, bathe and dress afterward.

Jane’s bathroom is equipped with a chair for the shower, which helps to ensure shower safety. These chairs are in the bathrooms of 35 residents with mobility problems. They have an ergonomic design, drain holes to prevent water collection, adjustable height, fixed armrests, and non-slip rubber feet. Chairs can also be designed for different weights and are easy to clean and store. However, I still need to assist her while she is taking a shower. So, when I enter the room in the morning, I say, “Good morning” and check if Jane is ready to bathe:

• If she is ready, I suggest helping her get to the bathroom or help her get into her wheelchair;
• Once we are in the bathroom, I carefully ask if she wants any assistance in undressing; if the answer is “yes,” I help Jane; if the answer is “no,” I tell her I will turn around and stay close in case she needs assistance;
• Jane takes a shower without my direct help because of the assisting equipment, but I continue to stay around to ensure her safety;
• Once Jane tells me she is finished, I help her get up because of the slippery floors;
• We come back to her bed, and I asks if she needs any help getting dressed;
• We pick an outfit for the day together, and I either hold Jane while she dresses or dress her myself, based on her answer;
• I help Jane go to the recreational area for some soup.

In the evening, following a similar procedure, I help Jane wash and change clothes before going to bed.

Jane has visitors who come to the institution once a month – her daughter and granddaughter. They ask me questions about Jane’s health and well-being, and I give them detailed answers. I also offer Jane some leisure options during such conversations to make her feel more active and fun. Jane is worried about her weakness, so we have developed for her and other patients with mobility problems a set of exercises that they perform every day in their free time under the supervision of a coach. She also takes some vitamins and supplements, as agreed with her doctor.

Communicating with Jane and her family is very helpful to me; by supporting Jane while bathing, I began to understand how delicate and vulnerable people are, regardless of age or gender. Sometimes, however, I feel the challenge of helping residents without imposing on their sense of privacy. I realize that sometimes Jane feels rater ashamed of others helping her get undressed, but she has no other choice but to seek assistance. For this reason, I realize how important it is for her to realize her autonomy and dignity.

In our nursing home center, there currently are 15 people with dementia. Our doctors and nurses have developed a treatment program for different types and stages of the disease. Alzheimer’s disease associated with dementia is incurable; still, scientists continue to look for ways to stop the breakdown of nerve endings in the brain, which leads to the loss of some abilities and skills. On day five, both the number of residents and the staff to patient ratio remained the same. The focus of my shift was on Mary, a 93-year-old patient with dementia.

On day five, I am assigned to work with Mary, our patient of eight years, as she has recently had issues with dressing. Because of her progressive dementia, Mary has issues with weather perception and easily forgets to put on certain pieces of clothing. The schedule for the day is as follows:

I come to Mary’s room in the morning in order to help her get dressed for the day:

• I say “Hello” and ask her how she feels; if there are any concerns, I listen to them, measure her BP in order to pass the data to her physician;
• I ask her about her preferences on what to dress and check-in by asking what she thinks about the weather, whether she feels hot or chilly;
• Based on her answer, together we think about what to wear for the day;
• I ask Mary’s permission to help her get dressed; if the answer is “yes,” I prepare the clothes and carefully assist Mary;
• If Mari does not need my help in getting dressed, I suggest we create a checklist for dressing and say “check” every time Mary puts on a piece of clothing, so she does not forget to put on underwear or other clothes;
• I stay close to Mary in case she becomes confused with putting on clothes;
• After she is done, I check on her and ask whether she feels comfortable;
• If everything is good, we proceed to the recreational area.

The procedure is repeated in the evening when Mary needs to change clothing before going to bed.

Mary’s grandson comes twice a month to talk to her and ask questions about her well-being, to which I give detailed answers. Mary can solve crossword puzzles, and she loves them very much, so her grandson brings her new crossword puzzles every time. Mary sometimes doesn’t recognize her grandson, but I keep reminding her that he is a close person she can trust. When her grandson is upset about Mary’s health and illness, I try to support him, and I always thank him for visiting because it’s hard for Mary to make new friends. Sometimes Mary remembers people from the past and tells us stories that her grandson enjoys listening to because he knows many of the participants personally.

I am always present during these meetings since this is part of my responsibilities. If Mary does not recognize her grandson or does not understand where she is, she should trust me through my nurse clothing and my communication skills. When Mary is scared, I explain the situation quickly and honestly and remind her that she can spontaneously forget some things.

Communicating with Mary helped me take a different perspective on dementia and avoid some myths. For example, it inspires the belief that patients with dementia are aggressive. But aggression can occur only when the health care provider does not understand its causes – fear and concern about not understanding the situation. Therefore, prompt explanations and gentle, friendly tone help reduce the risks of aggressive behavior. Another myth is the complete loss of mental abilities, which is not true. People with dementia retain the ability to think logically; they only partially lose the ability to remember certain events and recognize familiar faces. Sometimes, of course, it is hard to remain calm when you need to repeat the same things over and over again or when patients react aggressively to your comments, so it is important to keep in mind that their behavioral response comes from the place of illness, not wrongdoing.

Out of 100 patients currently residing in our nursing home, some use wheelchairs. A small part of these people cannot move due to complete loss of limbs mobility. The other part is people who recover after surgery or illness. Such people have working limbs but are temporarily using wheelchairs. On day six, I had to help William, who is 78 years old and had a stroke, move from bed to wheelchair. The workload was not heavier than usual, with an average of 5-6 patients per nurse.

One of the tasks I need to complete today is to help William get transferred from bed to chair. This is a rather complex procedure that requires skills and experience and takes place in several stages. Considering the routine for the day, this procedure needs to be done before 9 am:

At the beginning of my shift, I visit William, greet him, and wonder whether he is ready to get up:

• If he is ready, I come to his bed and roll his cart next to it;
• I help William take a sitting position on his bed and suggest he spends a few minutes to get used to the position and see if he feels well;
• To move, I place William on his side, facing the cart, and then I place one hand on the patient’s shoulder and bent his knees;
• I moved the patient’s legs off the edge of the bed and used this impulse to help him take a sitting position;
• I moved the patient closer to the edge so that his feet touched the floor;
• I make a turn, putting a belt on the patient’s knees that he could grab during the turn. Supporting the patient’s leg, I help him get up and move to the wheelchair.
• I ask the patient to touch the armrests and adjust the seat.

William has several visitors, a daughter with children comes to him every two weeks, and a son comes to him every two weeks. After the stroke, William’s children visited him more often, and now they are worried about his condition. William is also worried and nervous, although he tries to hide his feelings. Fortunately, if he follows the treatment plan, William has a good chance of a full recovery, but he will use a wheelchair for some time before that.

Moving a patient from bed to wheelchair has always seemed to be the most difficult practice. However, after I completed this task a few times, I felt more confident and understood that this is a simple skill. Moreover, I see that patients feel very grateful when someone helps them move around and feel like functioning adults. Seeing how people with limited mobility opportunities continue to interact with others is the most rewarding feeling, as they are not guilty of losing their ability to physically connect with society.

Description of the Immediate Setting

Our nursing home center is a large facility with a spacious seating area and a cozy courtyard with a walking park. Our center also has a gym and a board games area, so our residents have many options for recreational activities. They can also spend their free time in their rooms where no one will disturb them. However, from time to time, our residents need brighter emotions (Spangler et al., 2019). Therefore, we have a tradition of celebrating birthdays for those patients who consent and have the opportunity to participate in the celebration. The center’s current population of 100 people, celebrating birthdays and holidays, is a chance of feeling alive and connected to their lives. We organize public celebrations two or three times a month because not all residents like to attract attention. In terms of planning this activity, the staff-to-patient ratio is not as important, as every resident becomes a part of the party-planning committee, whereas nurses curate the process and help patients bring their ideas to life.

On day seven, the center’s schedule differs from the usual outline, as the majority of free time for the day is dedicated to the party planning:

On day seven, I am assisting a group of three patients: Linda, John, and Christine, who are volunteers for creating a karaoke activity for the party:

• During the activity planning, I ask patients who have any ideas whether they need my assistance in supplying and organizing something;
• Linda, John, and Christine pitch their idea of karaoke and wonder if we have a sound system to bring to the party;
• I assure them we will bring the system and ask them to create a list of songs they want to include in the catalog;
• I ask the facilities manager to bring the sound system;
• I go around and help Linda and others collect songs for karaoke activity;
• During the final stage of planning, we make a soundcheck, and I proceed with helping residents get dressed and groomed for the party.

Prior to every party, I consult with therapists and other medical staff on whether it is appropriate. I also create a list of patients who may need additional assistance during the party or even skip the party. Other nurses and I, along with patients, inform family members about the party, and they are free to visit as long as they are healthy and welcomed by the residents.

Undeniably, creating a party that would satisfy every resident is a nearly impossible task, especially concerning their unrealistic suggestions for the activities. However, seeing how happy they are once the party is started makes me realize that even one smile on their faces is worthy of my efforts. Hence, it motivates me to commit even more to my job and make sure every resident at the facility feels at home.

Spangler, D., Blomqvist, P., Lindberg, Y. and Winblad, U. (2019) ‘Small is beautiful? Explaining resident satisfaction in Swedish nursing home care’, BMC Health Services Research , 19(1), pp. 1-12. doi.org/10.1186/s12913-019-4694-9

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IvyPanda. (2023, February 20). Work Experience Diary of a Health Care Assistant. https://ivypanda.com/essays/work-experience-diary-of-a-health-care-assistant/

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IvyPanda . 2023. "Work Experience Diary of a Health Care Assistant." February 20, 2023. https://ivypanda.com/essays/work-experience-diary-of-a-health-care-assistant/.

1. IvyPanda . "Work Experience Diary of a Health Care Assistant." February 20, 2023. https://ivypanda.com/essays/work-experience-diary-of-a-health-care-assistant/.

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What to include: why i want to be a nurse essay.

Why do you want to be a nurse? What is your reason for entering the nursing profession? What drives you?

You will face these questions multiple times throughout your career, but there are two occasions in which answering them could actually define your career.

The first is when you apply to nursing school. You may be asked to complete an essay outlining why you want to become a nurse.

The second time is when you apply for a nursing position and answer that question as part of the interview process.

Whether you're applying for a nursing program or job, it's important to know how to address this question and what sort of answers work best.

What To Include In Your Nursing Essay

To create the perfect nursing essay, one that can help you get into nursing school or find your first job, follow the steps below:

Plan Your Nurse Essay

Before you start writing your nursing essay, think about what you want to include.

Jot down ideas that express your passion for the nursing profession, as well as any personal or familiar experience that led you to take this step.

Be honest. Be open. Summarize your story, highlight your goals, and think about what the nursing profession means to you.

All of these things will be important when structuring your essay.

Show an Emotional Connection to the Profession

Do you have any family members that worked as nurses or doctors? Did you care for a loved one during an illness? Did you require a lot of care at some point in your life?

If so, this should be your lead, and it's probably the most important part of your essay.

Nursing is a lucrative career. You can make a decent salary, enter numerous specialties, and even progress to opening your own practice. There is also a national nursing shortage, so you'll also have plenty of opportunities if you're willing to learn and work. But interviewers don't want to hear that you became a nurse to earn good money and pick up lots of overtime.

Think of it in the context of a talent show. We know that the contestants are there to get famous and make lots of money. But when they stand in front of the camera and appeal for votes, they talk about deceased parents/grandparents, changing their family's life for the better, and making a difference in the world.

It's easy to sympathize with someone who wants to follow in the footsteps of a beloved mother or make a grandparent proud. It's not as easy to sympathize with someone who just wants to drive a Bugatti and wear a Rolex.

Examples  :

"My mother is a nurse practitioner. I can see how happy the role makes her and how much it has changed her. I have looked up to her throughout my life and have always wanted to follow in her footsteps."

"I cared for my father when he was ill. I was able to comfort him and assist him in his time of need, and while it was very challenging, it always felt right to me and it's something I would love to do as a career."

Show That You Care

Like all health care workers, nurses are devoted to healing the sick. If you're not a people person, it's probably not the profession for you.

Make it clear that you're a caring person and are willing to devote your life to healing sick people. A good nurse also knows how to comfort distraught family members, so you may want to include this in your essay as well.

If you have any examples of times when you have helped others, include them. This is a good time to talk about volunteer work, as well as other occasions in which you have devoted your time to helping strangers.

"I feel a great sense of pride working with families and patients through difficult times. I like to know that I am making a difference in the lives of others."

"I want to become a nurse so that I can help others in their time of need. I chose nursing as a profession because I feel a great sense of accomplishment when helping others".

Share Your Aspirations

What are your goals for your nursing career? Do you want to become a nurse practitioner? Do you want to specialize as a nurse anesthetist, a critical care nurse, or focus more on pediatrics?

Nurses work across a range of specialties, and it's important to show that you are interested in continuing your education and developing to your full potential.

The goal is to show that you are determined. You are driven to succeed and to better yourself.

If you're just taking your first steps as a nursing student, now is a good time to research into specialties and get an idea of how you want your career to progress.

"I have always been drawn to the nursing profession because it's challenging, demanding, and interesting. I want to push myself every day, engaging my academic interests and satisfying my need to learn and improve as a person."

Describe Your Nursing Skills and Qualifications

If you're applying for an accelerated nursing program or a new nursing job, the interviewer will have access to your qualifications. But they won't know what those qualifications mean to you, what you learned from them, and how you can use them in your career.

It's about problem-solving skills, as well as academic work. It's about experience and personal growth, as well as knowledge acquisition.

This is a good time to talk about internships.

How Do You Write an Introduction to a Nurse Essay?

Starting is always the hardest part, but it's best not to overthink it.

Just start writing about why you want to become a nurse. Don't overthink it. Don't worry too much about the first word or sentence. Everything can be edited, and if you spend too long thinking about those first words, you'll never finish the essay.

Keep it simple, check your work, and edit it until it's perfect and says exactly what you want it to say.

Rules, Laws, and Statements

Laws, rules, and statements.

The Washington State Board of Nursing (WABON) enforces the statutes of Washington state in relation to the nursing profession.

Learn about Washington's nursing laws and regulations, as well as ongoing policy development areas and opportunities for public engagement, using the links below.

I am looking for:

Revised Code of Washington (RCW)

Washington administrative code (wac).

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• Hearings schedule
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• Policy and Legislation 
• Advisory Opinions

Definitions

A statute or Revised Code of Washington (RCW) is written by the Washington State Legislature. Once legislation is signed by the governor, it becomes law. You can perform an  online search for RCWs  on the Washington State Legislature website or go directly to the  full list of RCWs .

A rule or Washington Administrative Code (WAC) provides interpretive support for the individuals or entities to whom the rule or statute applies. Department of Health rules are written and adopted by a Board or Commission or the Secretary of the Department of Health. Rules or WACs carry the full force of the law. You can perform an  online search for WACs  on the Washington State Legislature website or go directly to the  full list of WACs .

Interpretive Statement

Interpretive statement are a written expression of the opinion of an agency as to the meaning of a statute or other provision of law, of a court decision, or of an agency order.  RCW 34.05.010 (8)

An interpretive statement does not have the force and effect of law. It is merely an explanatory document intended to convey the board’s interpretation of the law and regulation as it existed at the time the statement was issued.

Policy Statements

Policy Statements are written descriptions of the current approach of an agency, entitled a policy statement by the agency head or its designee, to implementation of a statute or other provision of law, of a court decision, or of an agency order, including where appropriate the agency's current practice, procedure, or method of action based upon that approach. RCW 34.05.010 (15)A policy statement informs the public of the board’s current approach to implementation of its own law or rule. A policy statement does not have the force and effect of law.

Advisory Opinion

Advisory Opinions are a written opinion in response to questions concerning the authority of various categories of nursing practitioners to perform particular acts. RCW 18.79.110

An advisory opinion does not have the force of law but may be considered by the board to be the standard of care in our state.

Stay connected

Sign up  to be notified by email of important information about the board rules as it becomes available. 

If you have questions, please contact our rules staff at  [email protected] . 

More agency rule resources

Department of Health Rule Making

State Board of Health Rules

Other Department rules in WAC Title 246

Rule Petition

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• Marquette 2031

Marquette College of Nursing opens doors to new home in Straz Hall 

• August 29, 2024
• 4 min. read

The College of Nursing has officially welcomed students into its new home in the reimagined David A. Straz, Jr., Hall at the start of this semester. The building underwent a radical transformation after serving as home to Marquette Business since its initial construction in 1951. 

This 103,000-square-foot, five-story building now houses a blend of general use classrooms, skills practice labs, health care simulation spaces, administrative offices and student study areas. Learning spaces are designed for active student learning and equipped with flexible technology to accommodate in-person and hybrid learning that can integrate students at a distance into the classroom. 

The new simulation center is equipped with an operating room, several hospital inpatient rooms, clinic space and a studio apartment meant to simulate home health care.  

“A boldly reimagined Straz Hall was a key next step in Marquette’s Campus Master Plan, allowing us to increase the capacity of the College of Nursing and meet a critical need for nurses in Wisconsin and beyond,” said Dr. Kimo Ah Yun, acting president, provost and executive vice president for academic affairs. “Marquette Nurses put courage and care into action, driving positive change for people, communities, health care and the profession. This state-of the-art facility is in the heart of campus and will be an integral part of a transformative experience for the next generation of nurses in Marquette’s Catholic, Jesuit tradition.” 

Student success, access and service are at the heart of Straz Hall’s new design. The expanded student lounges allow for easier collaboration among learners, while amenities such as lockers, kitchenettes and respite rooms make the building an inviting place to spend the day. Marquette Nursing can now accommodate more students than ever while expanding its long tradition of caring, intentional community. 

“Straz Hall allows us to expand the number of students we admit to the college, which is necessary to help alleviate the nursing shortage both locally and nationwide,” said Dr. Jill Guttormson, dean of the College of Nursing. “The investment of Marquette and our engaged alumni in this building is going to be transformational for the college. This state-of-the-art facility includes wraparound academic support for students and takes Marquette nursing to the next level, while providing a welcoming, inclusive environment for all.”  

With its undergraduate nursing program ranked 52nd nationally by U.S. News & World Report , the College of Nursing is poised to prepare as many as 5,000 new Marquette Nurses over the next decade as part of a bold expansion initiative that calls for increased enrollment and greater diversity. Through continued innovation in nursing education, Marquette is preparing nurses for the rapidly changing health care environment, poised to help mitigate healthcare disparities and be the nurse leaders of the future. 

What’s new in David A. Straz Jr. Hall  

• Health care simulation spaces include an operating room, several hospital inpatient rooms, clinic space and a studio apartment meant to simulate home and community health care. 
• Straz Hall now boasts ample room for study space and lounge seating in spaces that are flooded with natural light — a change from the college’s former home in Clark Hall, built in 1981, which does not have exterior-facing windows and relatively few spaces with natural lighting. 
• The first, second and third floors are dedicated to student learning spaces, and the fourth and fifth floors primarily contain offices for full- and part-time faculty, yet student study spaces are integrated throughout the building. 
• While it may now feel like one cohesive building, Straz Hall is built from a combination of four separate structures. The original building was constructed in the 1950s, and three separate additions were tied on in 1983, 1998 and 2024. This latest addition increased the building’s square footage by 35,000 gross square feet.

David A. Straz Jr. Hall facts  

• Remediation and removal began: January 2023 
• Open to students: Monday, Aug. 26, 2024 
• Square footage of renovation: 103,000 GSF 
• Square footage added: 35,000 GSF 
• Builder: J.H. Findorff & Son Inc.
• Mechanical and Plumbing: JM Brennan
• Electrical: Staff Electric 
• Designers: HGA, OTIE, Ring & Du 

U.S. News and World Report ranked Marquette’s undergraduate nursing program 52nd in the nation (2023). The College of Nursing’s Master of Science program is ranked 58th (2023); its Doctor of Nursing Practice program is ranked 85th (2023); and the Nurse Midwifery program is 22nd (2024). U.S. News ranked Marquette’s online graduate nursing program 36th in 2024. Recently rankings were added, which featured the college’s online program ranked 20th nationally for veterans. 

Sustainability at work  

The Straz Hall renovation is one of three capital projects to come online for the start of the fall semester—with the Lemonis Center for Student Success and the renovation of Chapel of the Holy Family , the Marquette community’s primary worship space. Each of these projects, as well as the Wellness + Helfaer Recreation Center due to open in January 2025, represent an investment in an existing building, adaptively reusing an existing building in the heart of campus and transforming it into something state-of-the-art intended to elevate the student experience. 

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How a Leading Chain of Psychiatric Hospitals Traps Patients

Acadia Healthcare is holding people against their will to maximize insurance payouts, a Times investigation found.

Acadia Healthcare’s Park Royal hospital in Florida is among those that wrongly held some patients against their will. Credit... Michael Adno for The New York Times

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By Jessica Silver-Greenberg and Katie Thomas

• Sept. 1, 2024

Acadia Healthcare is one of America’s largest chains of psychiatric hospitals. Since the pandemic exacerbated a national mental health crisis, the company’s revenue has soared. Its stock price has more than doubled.

But a New York Times investigation found that some of that success was built on a disturbing practice: Acadia has lured patients into its facilities and held them against their will, even when detaining them was not medically necessary.

In at least 12 of the 19 states where Acadia operates psychiatric hospitals, dozens of patients, employees and police officers have alerted the authorities that the company was detaining people in ways that violated the law, according to records reviewed by The Times. In some cases, judges have intervened to force Acadia to release patients.

Some patients arrived at emergency rooms seeking routine mental health care, only to find themselves sent to Acadia facilities and locked in.

A social worker spent six days inside an Acadia hospital in Florida after she tried to get her bipolar medications adjusted. A woman who works at a children’s hospital was held for seven days after she showed up at an Acadia facility in Indiana looking for therapy. And after police officers raided an Acadia hospital in Georgia, 16 patients told investigators that they had been kept there “with no excuses or valid reason,” according to a police report.

Acadia held all of them under laws meant for people who pose an imminent threat to themselves or others. But none of the patients appeared to have met that legal standard, according to records and interviews.

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Expensive medications you’ll save thousands. dementia or mental health care more options.

Kimberly Lankford,

Key takeaways

• Changes from Inflation Reduction Act will take effect next year.
• Lower out-of-pocket limit in Part D drug plans erases old “donut hole.”
• You may find weight loss drugs covered to treat other medical conditions.
• Your Medicare Advantage plan may not stay the same.
• Look for a midyear statement from your MA plan.
• Caregivers for loved ones with dementia may be eligible for respite care .
• More mental health counselors are encouraged to enroll as providers.

You can thank the Inflation Reduction Act of 2022 for some of the biggest Medicare changes in the past few years — including a welcome reprieve from the high costs of prescription drugs.

Among the changes:

In 2023 , Medicare capped covered insulin costs in Part D prescription drug plans at $35 a month and eliminated out-of-pocket costs for recommended vaccines.

In 2024, the government expanded eligibility for financial assistance from the Part D Extra Help program and announced results Aug. 15 of negotiations to reduce the costs of 10 of Medicare’s most expensive drugs . Those prices will take effect in 2026.

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One of the biggest changes takes effect in 2025, when Part D plans must cap out-of-pocket spending on covered drugs at $2,000 a year. That change will have a ripple effect on Part D and Medicare Advantage plans’ other costs and coverage, making it especially important to review your options during open enrollment this year.

The Part D rules overshadow other Medicare changes that can make a difference in 2025, including Medicare Advantage midyear coverage notices and stricter marketing rules, expanded benefits for family caregivers and access to more mental health providers.

1. $2,000 out-of-pocket spending cap for prescriptions

The $2,000-a-year out-of-pocket limit for prescription medications applies to stand-alone Medicare Part D policies and drug coverage in Medicare Advantage plans.

“It’s the first time in the history of the Medicare program that people have a cap on how much they could have to pay out of pocket,” Meena Seshamani, M.D., the director of the federal Center for Medicare, said in an interview with AARP. “And such a significant change means that in open enrollment, it is so important to shop. Because with such big changes, there very well could be a plan that better suits your health and financial needs.”

The $2,000 cap includes deductibles, copayments and coinsurance for covered drugs. It doesn’t apply to premiums or to drugs a plan doesn’t cover.

“It doesn’t apply to their Part B drugs,” such as injections they get at their doctor’s office, says Gretchen Jacobson, vice president of Medicare for the Commonwealth Fund. The amount of the cap can be adjusted in subsequent years if Part D costs rise.

2. No more Part D ‘donut hole’ or coverage gap

This change simplifies the way Part D works. Before 2025, plans had four coverage phases.

• Deductible. You pay the full cost of drugs until you meet your deductible, up to $545 in 2024.
• Initial coverage with copayments that vary by medication.
• Coverage gap , which occurs when you and your drug plan reach $5,030 spent on covered medications in 2024. It was known as the “donut hole.” Plans pay less in this gap, especially for brand-name drugs, and have dispensing fees. You may pay more out of pocket for the same meds than in your initial coverage period.
• Catastrophic coverage begins at $8,000, based on your out-of-pocket costs, not the insurer’s share, and manufacturers’ discounts in the coverage gap. In the catastrophic phase in 2024, you pay nothing for your covered prescriptions until the new year, Jan. 1, 2025.

In 2025, Part D plans can have a deductible up to $590. Then you pay copayments for your medications until your total out-of-pocket costs reach $2,000.

The cap is expected to help millions of people. By April 1, 2024, more than 1.7 million people, about 3.5 percent of people covered in drug plans, had already reached $2,000 in out-of-pocket costs on their prescriptions, according to the Centers for Medicare & Medicaid Services (CMS). More certainly will surpass that by the end of the year.

People with high drug costs tend to pay a lot at the beginning of a year. The Medicare Prescription Payment Plan will let enrollees opt to pay their prescription costs monthly rather than all at once.

“This will enable people to spread out the out-of-pocket drug costs over the course of the year so that you don’t experience that sticker shock and those cash flow issues at the pharmacy,” Seshamani says.

The payment plan doesn’t reduce the total cost, but it can help with budgeting. You can opt into the plan by contacting your Part D company.

The caveat. “There was some concern that changes in the Medicare Part D benefit design that lower costs for beneficiaries, like the $2,000 cap, would lead to higher premiums for 2025,” says Tricia Neuman, executive director for KFF’s program on Medicare policy. The $2,000 cap doesn’t include premiums.

“The Inflation Reduction Act included a 6 percent cap on base Part D premiums, but the cap does not apply to the total premium that individual plans may charge,” she says. Part D plans will have to cover a larger share of the costs beyond the cap. Drug manufacturers and Medicare also contribute to the cost beyond the cap.

The 2025 Part D base premium is $36.78, but actual premiums vary depending on your location and plan.

“They [CMS officials] don’t want beneficiaries to have to end up paying more in premiums because they get a cap on their out-of-pocket expenses,” the Commonwealth Fund’s Jacobson says.

The bottom line: You may see a big variation in premiums, copayments and covered drugs during open enrollment this year. Look at the annual notice of change that your plan must send in September outlining changes to your plan for 2025.

Starting Oct. 1, you can compare coverage and costs for all the plans in your area using the Medicare Plan Finder and choose a 2025 plan during open enrollment from Oct. 15 to Dec. 7. You can get help for free from your State Health Insurance Assistance Program (SHIP).

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3. More ways to get weight loss drugs

Medicare is prohibited from covering drugs prescribed specifically for weight loss . But Part D plans can cover popular weight loss drugs when they’re ordered for other purposes, such as Ozempic and Mounjaro for type 2 diabetes.

In March, the Food and Drug Administration approved Wegovy for people with cardiovascular disease who are overweight. Few Part D plans added the drug to their approved lists because they can’t change premiums midyear.

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“I looked at 83 stand-alone Part D plans and 235 Medicare Advantage plans in four cities, and only two plans covered Wegovy,” says Diane Omdahl, author of Medicare for You: A Smart Person’s Guide. She’s president of 65 Incorporated in Mequon, Wisconsin, which helps people with Medicare decisions.

However, you may find more weight loss drugs covered in 2025.

“We estimate that roughly 1 in 4 Medicare beneficiaries with obesity or who are overweight could be eligible for Wegovy to reduce the risk of serious heart disease,” Neuman says. “On the one hand, Wegovy is likely to be subject to relatively high cost-sharing because of its high price, but on the other hand, Part D enrollees who take these drugs will benefit from having the new $2,000 cap on their drug expenses.”

Part D plans can expand coverage as the FDA approves other uses for weight loss drugs.

Medicare does not cover Zepbound (tirzepatide) because the FDA has approved it only for weight loss. If the agency OKs tirzepatide for treatment of moderate to severe obstructive sleep apnea and obesity, which pharmaceutical giant Eli Lilly requested, Part D plans could cover the drug for that purpose.

4. Subtle changes to your Medicare Advantage coverage

The $2,000 out-of-pocket spending cap applies to deductibles, copayments and coinsurance in the prescription drug portion of Medicare Advantage plans.

Medicare Advantage plans may make changes in 2025 to help cover their additional expenses. They are less likely than Part D plans to adjust premiums, especially if they charge nothing in addition to the Part B premium , says Meredith Freed, senior policy manager with KFF’s program on Medicare policy.

No extra premium? Probably safe. “The zero-dollar premium is really attractive to people and one of the easiest ways to compare across plans,” she says. But a plan may change its formulary , which is its list of covered drugs; reduce its out-of-pocket maximum spending limit; increase the percentage you pay for some services, called coinsurance; or reduce some of the extra benefits that drew you to the plan in the first place.

“If you still have a dental benefit, for example, maybe it’s a little less generous than in prior years,” Freed says.

The devil’s in the details . Review your plan’s annual notice of change carefully. Don’t just rely on the general description of coverage in the Medicare Plan Finder when comparing Medicare Advantage plans.

Look at the details in the Explanation of Benefits on the plan’s website before making a final decision. Also reconfirm that your providers are in the plan’s network.

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5. Midyear statement from your Medicare Advantage plan

This will matter to Medicare beneficiaries who have chosen Advantage plans instead of original Medicare, 50.4 percent as of April 2024. The midyear statement will show available benefits that you haven’t used — important since those extras are often what persuades a Medicare enrollee to sign up with a particular plan.

“For example, if they haven’t used any of their dental, vision, hearing or fitness benefits, plans are required to notify them if they have any benefits left,” Jacobson says.

You’ll continue to see more realistic TV ads from Medicare Advantage plans, the private insurance alternative to original Medicare. Rules that took effect last year before open enrollment prohibited Medicare Advantage ads from mentioning benefits not available in the area where the ad appears. The ads also can’t mislead you into thinking you’re contacting a government employee when you call with questions.

6. Expanded program for family caregiver services

A program for dementia patients and their caregivers that launched this year will quadruple in 2025, serving more of the country.

The program, called Guiding an Improved Dementia Experience (GUIDE), provides a 24/7 support line, a care navigator to find medical services and community-based assistance, caregiver training and up to $2,500 a year for at-home, overnight or adult day care respite services. Patients and their caregivers typically won’t have copayments.

Adding 294 to original 96 . CMS selected 96 organizations to participate starting July 1, 2024, including academic medical centers, hospitals, small and large group practices and community-based organizations already providing programs for dementia patients. The agency chose 294 organizations to join next July.

“We’re very excited about this,” says Janet LeClair, CEO of Memory & Movement Charlotte (North Carolina), a nonprofit medical practice that has focused on dementia patients for 11 years. “The caregiver is really the pivotal person ensuring the quality of life of the patients.”

Important criteria. Participants must be enrolled in original Medicare and have a dementia diagnosis. They can’t be in hospice or a nursing home.

“We know intuitively that respite is so critical to the health and well-being of the caregiver, which directly correlates to the health and wellness of the patient,” LeClair says.

To see if a program is available in your area, go to the CMS GUIDE program fact sheet and the link to the CMS Innovation website . Click GUIDE Model in the drop-down models list | Display selected .

Programs that will begin in July 2025 are listed. Contact the program to learn more about eligibility and request an assessment.

7. A push to add more mental health providers to Medicare

Although the percentage of adults 65 and older reporting they used mental health services increased by only 1 point to 20 percent from 2019 to 2022, according to a KFF study , access to care may have affected those numbers. 

Before this year, licensed marriage and family therapists, mental health counselors and addiction counselors couldn’t bill Medicare because they weren’t allowed to enroll as Medicare providers. Now they can, and some have.

A paperwork process. “But it’s not just automatic. There are steps they need to take,” Freed says.

Medicare Advantage plans must meet stricter standards to improve access to behavioral health specialists.

“We’ve had such tremendous excitement and interest with tens of thousands of clinicians enrolling in the Medicare program, which will make a big difference for access to care,” Seshamani says. More than 400,000 behavioral health clinicians nationwide are eligible, but you’ll need to ask any provider you seek if they accept Medicare.

Positive development: Even though many telehealth expansions that took effect during the COVID-19 pandemic will expire at the end of 2024, Medicare permanently expanded access to telemedicine for behavioral health services. That can help with access to providers, especially in rural areas.

Kimberly Lankford is a contributing writer who covers Medicare and personal finance. She wrote about insurance, Medicare, retirement and taxes for more than 20 years at  Kiplinger’s Personal Finance  and has written for  The Washington Post  and  Boston Globe . She received the personal finance Best in Business award from the Society of American Business Editors and Writers and the New York State Society of CPAs’ excellence in financial journalism award for her guide to Medicare.

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