A Day in the Life of a Long-Term Care Nurse Practitioner

If you work in healthcare, you’re likely aware that older adults are the fastest-growing segment of our population. The “baby boomers” are reaching retirement age, plus people are living longer with more chronic conditions due to advances in medical care and technology. This means we need more qualified and committed providers prepared to care for them!

I went through my NP program with the ultimate goal of caring for older adults in a long-term care center (nursing home). After two years in family practice, I got the opportunity to do so! In this post, I’ll share my story and what a typical day looked like working in long-term care. This will give you some insight into this career path for family nurse practitioners (FNPs) or adult-gerontology primary care nurse practitioners (AGPCNPs).

Here’s how my journey to becoming a long-term care nurse practitioner began.

Why did I become a long-term care nurse practitioner?

As an RN, I worked in a small community hospital on the telemetry and medical-surgical floors. The majority of the people I cared for were older adults, and I really developed a passion for helping that patient population. I enjoyed the connections I made with them, including learning their histories and unique life stories and experiences.

I also really enjoyed the challenge and critical thinking that came with chronic disease management. You have to look at the big picture and how all the different pieces come together to determine a plan of care. I found caring for older adults to be rewarding in so many ways!

What was a typical day like?

While working as a long-term care nurse practitioner, I was also a full-time faculty member. This meant I’d round on patients usually once, maybe twice, per week. The centers I worked in were small, but larger facilities definitely utilize full-time providers, like nurse practitioners and physicians. 

My days were very flexible and I had the freedom to make my own schedule, including my start and end times. I told the administration and staff what my schedule was, so they knew when I was going to see patients.

Preparing for Patients

To prepare for patient visits, I would ask the nursing staff to put patients on my schedule as issues or concerns arose during the week. There was always a physician on call for emergent issues, but since the staff knew I would be coming on certain days of the week, they’d prepare a list of acute visits based on patient needs.

I also had a list of new admissions, follow-up visits, as well as monthly and yearly exams needed per different insurance regulations.

Patient Visits

Once I had my list, I would go see my patients! I would coordinate with staff to be able to assess patients in their rooms.The facilities I worked in had an average census of around 100-200 patients and I would usually see about 12-15 patients on the days that I rounded. That may not sound like a lot of visits, but these patients normally had very complex medical histories and conditions.

There wasn’t a designated “exam room” and I needed to be sure to maintain patient privacy. For example, I would avoid examining patients in the activities room or in the therapy gym for that reason. This was challenging at times depending on schedules for therapy, activities, or specialty visits, but the staff were very helpful in making sure patients were in their rooms if they were on my list to be seen. 

Charting & Orders

After examining patients, I would discuss plans with the staff and begin to chart and enter orders. I did a lot of managing chronic conditions like heart failure, chronic kidney disease, diabetes, and dementia. I also did a lot of phone calls and meetings with family members to update them on care, and sometimes even had difficult conversations when their loved ones started to decline.

For a more detailed breakdown of a day in the life, check out this video on the SMNP Reviews YouTube channel!

Overall, I really enjoyed the complexity of the care. Chronic disease management can be tough because you really have to think about how all the medications and treatments will affect each body system. I was always reviewing kidney function, looking up drug interactions and side effects because of multiple prescriptions, and coordinating care between specialists. But I loved it!

Long-Term Care vs. Skilled Nursing

Over the course of my career, I’ve had the opportunity to work with so many great providers. This afforded me the opportunity to see the difference between two important lines of work: long-term care and skilled nursing. I’d like to spend a bit of time now highlighting the difference between the two, so you can have a sense of the different career paths out there.

Long-Term Care Centers

I’ll start by explaining the difference between a long-term care center and a skilled nursing facility. A long-term care center is what is traditionally known as a nursing home. That means a permanent place of residence for adults who are unable to care for themselves. They may be completely dependent on care with severe limitations in mobility or cannot care for themselves due to cognitive impairments. Caring for these patients involves a lot of chronic disease management, as well as psychosocial and palliative care.

Skilled Nursing Facilities

In contrast, think of skilled nursing facilities as rehab centers. These patients may be recovering from major surgery or illness and need help with the transition from the hospital to back home. They’ll be receiving services like wound care, physical, occupational, and speech therapy, and tend to require subacute management of conditions.

For example, at times in my career I’ve cared for patients that were recovering from prolonged hospitalizations, so I would help to manage any concerns related to the hospitalization while bridging the transition to get them back home.

My Experience

Over the years, I’ve worked in long-term care facilities that had units for skilled nursing patients. That means I had the opportunity to work with so many different specialties in health care. I helped to coordinate patient care between physicians, nursing staff, therapists, pharmacists, social workers, and administrators. It was great feeling like I always had someone I could reach out to and discuss things with to make sure the patient received the care that they needed.

The bottom line is, working in a long-term care facility (or nursing home) means treating patients who are unable to return home, whereas a skilled nursing facility is a rehab center. Only you can decide which setting is the best fit for you!

A Common Question

A common question I would get asked was, “Can I work in long-term care as an FNP, or do I need a different certification?”

The answer is yes, you can do it as an FNP! But, we always recommend carefully reviewing the job description and the scope of practice for NPs in your state. In my position, I wasn’t doing any invasive procedures or monitoring, including any IV medications or high-risk disease management. There are some skilled nursing facilities that care for patients of a higher acuity, which in that case would have been outside of my scope of practice.

If you’re thinking about working in a skilled nursing facility, you can certainly do that right after graduating from NP school. But I will say my two years in family practice gave me a great foundation in chronic disease management. 

Depending on what course you choose to pursue, I also highly recommend trying to complete some clinical hours for your NP program in a long-term care or skilled nursing facility if you can. That way, you can explore your interests as well as gain valuable training and experience. 

Final Thoughts

I think long-term care centers and skilled nursing facilities get a bad reputation as being depressing, but for me they were places where I had an opportunity to care for some of our most vulnerable. Older adults all have a beautiful story to tell and it was a great privilege to be able to care for them!

If you’re interested in exploring other NP roles, be sure to check out the SMNP Reviews YouTube channel. Our instructors share their stories of working in retail clinics, orthopedics, interventional radiology, and more. There are endless NP possibilities! 💜

Or, explore even more “day in the life” posts from real-deal NPs:

• A Day in the Life of a Primary Care Family Nurse Practitioner
• A Day in the Life of a Nurse Practitioner: Primary Care Pediatrics
• A Day in the Life of a Nurse Practitioner: Adult-Gerontology Primary Care (AGPCNP)