working in a nursing home essay

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

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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 / Blog

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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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 .

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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, related articles.

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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.

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• 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

*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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97 Nursing Home Essay Topic Ideas & Examples

🏆 best nursing home topic ideas & essay examples, 📌 simple & easy nursing home essay titles, 🔎 most interesting nursing home topics to write about, ❓ nursing home research questions.

• Issue of Falls at a Nursing Home: Professional Reflection The problem of patients’ falls in nursing homes is an urgent nursing issue, and my experience in one of these institutions in New Zealand is the object of evaluation.
• Quality Costs for Building a Dementia Nursing Home Firstly, there will be the inclusion of the appraisal costs which entails the inspection and measurement of activities when the operation is ongoing to determine their conformity to the required standards. We will write a custom essay specifically for you by our professional experts 808 writers online Learn More
• Older Patients’ Transition From a Hospital to a Nursing Home The example of transition of care chosen for further exploration is concerned with the transition of care from the hospital to the nursing home setting for patients that came to receive healthcare for various conditions.
• The Rehabilitation Center and Nursing Home During the evaluation process, the nurse leader identifies the problems in the organization and determines the strong and weak points, resources, gaps, and other factors that determine how the project will develop.
• A Nitrogen Gas Accident at a Nursing Home The nursing home workers failed to recognize this error and did not check the gas before hooking the tanks to the system.
• Approach to Learning at Cloudview Nursing Home Since the approach adopted to learning determines an organization’s performance, it is essential to understand the motivations for learning and their influence on workplace education.
• Regulation of a Large For-Profit Nursing Home Chain To solve the problem of unlawful actions of the stakeholders in nursing homes, there is a need for the implementation of the practical management theory.
• “Implementation and Effects of MRC in a Nursing Home” by Henskens The research’s dependent variable is the outcome to be measured the treatment’s impact on the aforementioned patients’ ADL and QoL. However, the researchers did not provide a clear delineation of the above-mentioned variables in the […]
• Nursing Home Beds: Fundamental Uncertainty and Values If it is assumed that the admission will stay the same, the decision to dismiss a certain amount of employees will reduce fixed costs in both facilities.
• A Nursing Home Working Scenario Working in nursing homes has its opportunities and challenges; therefore, the paper will cover the multidisciplinary teams’ working scenario, their interaction and diversity, communication in client care, and support accorded to clients considering their family, […]
• Nursing Home Blueprint and Requirements The aim of the facility should be geared towards the promotion of the health of the old patients through the prevention and treatment of diseases and disabilities.
• Departmental Budget Preparation for Nursing Home However, while the total population in our area of operation is expected to decrease, the population of people who are above 65 years in the US is projected to rise.
• Northern Cochise Nursing Home: Federal and State Surveys Following the findings of the health inspection carried out by Arizona Department of Health Services, the management of the Northern Cochise Nursing home took immediate steps to correct the deficiencies.
• Redondo Nursing Home: Providing Above Average Care While the potential resident and family members are expected to disclose all information pertaining to medical conditions, the planner is required to provide a complete description of the home.
• Organization Strategic Plan for a 40 Bed Nursing Home Unit The core values are to ensure that a team of the highest quality and honesty in delivering services attends to all.
• Activities Coordinator and a Conflict of Interest Situation at Cooinda Nursing Home It is thereby imperative that the practitioner adhere to the guidelines set by the home in such regards because he needs to check how his values and emotions are at par with the organizations, and […]
• Satisfaction With a Transitional Nursing Home Project The abstract does mention the dependant variable of the study viz.satisfaction with the transitional program; it does not, however, mention and discusses the various dimensions of the dependant variable that were measured in order to […]
• Nursing Home Designs: Health and Wellness of Aging The Eden Alternative is a nursing home model of care that places decision-making power into the hands of its clients and their families.
• Future Care Nursing Home in Baltimore City In the United States, up to one-half of the citizens will spend at least a few years of their lives in a nursing home.
• Healthcare Research at Pearl City Nursing Home I can conclude that the methods used in our work are effective and improve the quality of patient care in the Pearl City Nursing Home.
• Nursing Home and Its Impact on Lifespan A nursing home is a special nursing facility where the old, the mentally, and the physically challenged or handicapped people in society are taken care of.
• Choosing an Adult Foster Home or a Nursing Home A nursing home is well known to health and social services professionals as the long-term care service for older adults that accounts for that vast majority of public funding.
• Blumberg’s Nursing Home’s Staffing Crisis The present paper will seek to assess the current needs of the facility and develop a useful HR policy for inappropriate conduct.
• Blumberg’s Nursing Home: Staffing Crisis The situation under analysis is complicated due to the level of awareness and the necessity to take immediate steps and fill the unstaffed positions.
• Employee Compensation and Benefits. Senior Secretary at Capital Nursing Home Limited The proposal demonstrates that the value of the employee’s benefits augmented with the annual salary and provides the total compensation. The total compensation package for the position of Senior Secretary includes the base pay and […]
• Fernhill Nursing Home Run by Colten Care Limited Staff management for my team is my responsibility; and of course I am a nurse so my basic role is providing general nursing care to the residents and any other role that might be allocated […]
• Reduce Hospitalization of Nursing Home Residents Publicity of INTERACT as a program having the necessary infrastructure and leadership commitment in health care matters for the elderly is one promising way that can be used to overcome these issues.
• The Effects of Group Music Making on the Wellbeing of Nursing Home Residents
• Assessing French Nursing Home Efficiency
• Assessing Nursing Home Care Quality Through Bayesian Networks
• Can Family Caregiving Substitute for Nursing Home Care
• Cost (In)Efficiency and Institutional Pressures in Nursing Home Chains
• The Difference Between Nursing Homes and Retirement Homes
• Direct Care Workers’ Response to Dying and Death in the Nursing Home
• Does Paid Family Leave Reduce Nursing Home Use
• Economic Disability and Health Determinants of the Hazard of Nursing Home Entry
• Effective Human Resources Leadership for Nursing Home
• Elder Abuse Within Nursing Home Setting
• Elderly Falls Within the Nursing Home
• End-Of-Life Decision Making for Nursing Home Residents With Dementia
• Impact of Family Structure on the Risk of Nursing Home Admission
• Nursing Home Facility Versus a General Acute Care Hospital
• Improving Wound and Pressure Area Care in a Nursing Home
• Nursing Home Environment and Pet Therapy Programs
• The Effects of 1935’s Social Security Act on the Nursing Home Industry
• Nursing Home Care Versus Assisted Living Care
• Health Care Utilization Nursing Home Administration
• Nursing Home Staff Turnover and Better Practices
• Mental Disorders Among Non-Elderly Nursing Home Residents
• Forecasting Nursing Home Utilization of Elderly Americans
• Incorporating Quality Into Data Envelopment Analysis of Nursing Home Performance
• Interventions That Encourage High-Value Nursing Home Care
• Lateral Violence and Uncivil Behavior in a Nursing Home
• Medicaid and the Cost of Improving Access to Nursing Home Care
• Medicaid Reimbursement and the Quality of Nursing Home Care
• Who Makes the Decision to Go to a Nursing Home
• Understanding the Medical Aspect of a Nursing Home
• The Fate and Welfare of Nursing Home Residents
• The Social Security Act of Nursing Home Facilities
• Physical Restraint in Nursing Home Facilities
• Predicting Nursing Home Utilization Among the High-Risk Elderly
• How Many Nursing Home Residents Live With a Mental Illness
• Improving the Nursing Home: A Framework for Professional Nursing Practice
• Incapacitated vs. Incompetence: Employees in the Nursing Home Industry
• An Argument in Enhancing the Care Quality in a Nursing Home
• How to Prevent Accidents in Nursing Homes
• Positive and Negative Views of Nursing Homes
• What Are the Benefits of Living in a Nursing Home?
• Do People Live Longer at Home or in a Nursing Home?
• What Is the Main Purpose of a Nursing Home?
• Why Is Assisted Living Better Than a Nursing Home?
• Which Are the Most Important Problems of Nursing Home Residents?
• How Do You Know When Someone Is Ready for a Nursing Home?
• What Participation and Knowledge Are Associated with Nursing Home Admission Decisions Among the Working-Age Population?
• Is It Bad to Put Your Parents in a Nursing Home?
• What Is the Most Common Diagnosis in Nursing Homes?
• How Did the Social Security Act of 1935 Affect the Nursing Home Industry?
• Can a Doctor Put Someone in a Nursing Home?
• How Can You Improve the Quality of Life in a Nursing Home?
• What Are the Most Common Reasons Seniors Are Placed in a Nursing Home?
• Are Nursing Homes Better Than Care Homes?
• What Is the Difference Between a Nursing Home and a Senior Home?
• How Can the Risk of Violence in Nursing Homes Be Reduced?
• What Are the Perspectives and Expectations of Telemedicine Opportunities from Families of Nursing Home Residents and Nursing Home Caregivers?
• How Do You Deal with the Guilt of Putting Your Parents in a Nursing Home?
• What Percentage of Nursing Home Residents Are Depressed?
• Is a Nursing Home the Best Choice for the Elderly?
• What Are the Physical, Intellectual, Emotional, and Social Benefits of Various Stimulating Activities for Nursing Home Residents?
• How to Deal With Collateral Violence and Indecent Behavior in a Nursing Home?
• What Are Nursing Home Residents’ Views on Dying and Death?
• How Often Should You Visit Your Mother in a Nursing Home?
• What Is the Difference Between a Residential Care Home and a Nursing Home?
• Should Elderly Parents Live in a Nursing Home or Not?
• What Is the Social Security Act of Nursing Home Facilities?
• How Can Human Resources Improve Nursing Home Management?
• What Are the Disadvantages of Living in a Nursing Home?
• How Important Is the Medical Aspect of a Nursing Home?
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Nursing Essay Examples

Nursing Essay Examples That Will Help You Write a Stellar Paper

Published on: May 6, 2023

Last updated on: Jan 29, 2024

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Many nursing students struggle with writing effective nursing essays, which are an essential part of their education and professional development.

Poor essay writing skills can lead to low grades and an inability to effectively communicate important information.

This blog provides a comprehensive guide to writing nursing essays with examples and tips for effective writing. Whether you are a nursing student or a professional looking to improve your writing skills, this blog has something for you. 

By following the tips and examples provided, you can write compelling nursing essays that showcase your dedication to the field.

Let’s get started.

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What is a Nursing Essay?

A nursing essay is a type of academic writing that aims to explore a particular topic related to nursing. It also presents a clear and concise argument or viewpoint supported by evidence. 

Nursing essays can take many forms, including:

• Descriptive essays
• Reflective essays
• Analytical essays
• Persuasive essays

What is the Importance of the Nursing Essay?

Nursing essays are important for several reasons. First, they help nursing students develop critical thinking skills by requiring them to analyze and evaluate information.

Second, they help students develop research skills by requiring them to locate and use credible sources to support their arguments. 

Third, nursing essays help students develop communication skills by requiring them to present their ideas clearly and concisely in writing. Finally, nursing essays are important for nursing education because they prepare students for the types of writing.

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To help students better understand how to write nursing essays, it can be helpful to review examples.

Below are some examples of nursing essays.

Nursing School Essay Examples

College Nursing Essay Examples

Graduate Nursing Essay Examples

Nursing Scholarship Essay Examples

Nursing Essay Conclusion Examples

Nursing Essay Examples of Different Fields

Nursing is a diverse field with many different specialties and areas of focus. As a result, nursing essays can take many different forms and cover a wide range of topics. 

Given below are some examples of different types of nursing essays:

Personal Philosophy Of Nursing - Essay Examples

Cal State Fullerton Nursing Essay Examples

Evidence Based Practice Nursing In Medical Field - Essay Examples

Leadership In Nursing And Healthcare Professionals - Essay Examples

Principles Of Professional Practice Of Nursing Professionals And Pharmacists

If you're seeking additional examples of nursing essays, you're in luck! 

Below are some more examples that can help you gain a better understanding of nursing essays:

Health Care And Reflective Models For Nursing - Essay Examples

History Of Nursing Essay Examples

Ethical Dilemma In Nurses Work - Essay Examples

Mental Health Nursing Essay Examples

Why I Want To Be A Nurse Essay

Working In A Team And Collaboration In Nursing

How to Write a Nursing Essay

Writing a nursing essay can seem daunting, but with the right approach, it can be a rewarding experience.

Here are the key steps involved in writing a nursing essay:

Understanding the Topic and Question

The first step in writing a nursing essay is to carefully read and understand the topic and question. 

This will help you determine what information you need to research and include in your essay. Make sure you understand any key terms or concepts related to the topic. Consider different perspectives or viewpoints that may be relevant.

Researching the Topic

Once you have a clear understanding of the topic and question, it's time to research. 

Start by gathering information from credible sources such as academic journals, textbooks, and government websites. 

Consider both primary and secondary sources, and make sure to take detailed notes as you read.

Organizing and Outlining the Essay

Once you have completed your research, it's time to organize your ideas and create an outline for your essay. 

Start by identifying the main points or arguments you want to make, and then organize them into a logical order that flows well. 

Your outline should include an introduction, body paragraphs, and a conclusion.

Writing the Essay

With your outline in place, it's time to start writing your essay. Make sure to follow your outline closely, and use clear and concise language that effectively communicates your ideas. 

Use evidence from your research to support your arguments, and cite your sources appropriately.

Editing and Revising the Essay

Once you have completed a first draft of your essay, take some time to edit and revise it. Look for any errors in grammar, spelling, or punctuation, and make sure your essay is well-organized and flows well. 

Consider asking a peer or instructor to review your essay and provide feedback.

What To Include In Your Nursing Essay

When writing a nursing essay, there are several key elements that you should include. Here are some important things to keep in mind:

• Introduction

Your introduction should provide a brief overview of the topic and purpose of your essay. It should also include a clear thesis statement that presents your main argument or point of view.

• Background Information

Provide some background information on the topic to help the reader better understand the context of your essay. This can include relevant statistics, historical information, or other contextual details.

• Evidence and Examples

Use evidence and examples from your research to support your arguments and demonstrate your knowledge of the topic. Make sure to cite your sources appropriately and use a variety of sources to strengthen your argument.

• Analysis and Evaluation

Provide analysis and evaluation of the evidence and examples you've presented. This can include discussing strengths and weaknesses, comparing and contrasting different viewpoints, or offering your own perspective on the topic.

Your conclusion should summarize the main points of your essay and restate your thesis statement. It should also offer some final thoughts or suggestions for further research or action.

Nursing Essay Topic Ideas

Choosing a topic for your nursing essay can be challenging, but there are many areas in the field that you can explore. Here are some nursing essay topic ideas to consider:

• The role of technology in nursing practice
• The impact of cultural diversity on healthcare delivery
• Nursing leadership and management in healthcare organizations
• Ethical issues in nursing practice
• The importance of patient-centered care in nursing practice
• The impact of evidence-based practice on nursing care
• The role of nursing in promoting public health
• Nursing education and the importance of lifelong learning
• The impact of nursing shortages on healthcare delivery
• The importance of communication in nursing practice

These are just a few ideas to get you started. You can also explore other topics related to nursing that interest you or align with your academic or professional goals. 

Remember to choose a topic that is relevant, interesting, and feasible to research and write about.

Tips for Writing an Effective Nursing Essay

Writing a successful nursing essay requires careful planning, research, and attention to detail. Here are some tips to help you write an effective nursing essay:

• Writing Concisely and Clearly

Nursing essays should be written in clear and concise language, avoiding unnecessary jargon or technical terms. Use simple language and short sentences to help ensure that your ideas are communicated clearly and effectively.

• Stating a Clear Thesis Statement

Your thesis statement should clearly state your main argument and provide a roadmap for the rest of your essay. It should be clear, concise, and located at the end of your introduction.

• Using Proper Citation and Referencing

Citing and referencing your sources is crucial in any academic writing, including nursing essays. Make sure to use proper citation and referencing styles, such as APA or MLA. Include a reference list or bibliography at the end of your essay.

• Seeking Feedback and Revising

Before submitting your nursing essay, seek feedback from peers, professors, or writing tutors. Use their feedback to revise and improve your essay. Make sure that it is well-structured, coherent, and effectively communicates your point of view.

By following these tips, you can write a nursing essay that demonstrates your knowledge and skills in the field.

In conclusion, writing a successful nursing essay requires careful planning, research, and attention to detail. 

To showcase your knowledge in the field of nursing, it is important to have a clear understanding of the topic at hand. When writing your nursing essay, be sure to include relevant examples, incorporate current research, and use proper citation and referencing. 

And remember , seeking feedback and revising your essay is key to ensuring that it effectively communicates your ideas and arguments.

If you need help with your nursing essay or any other type of academic writing, consider using our AI essay writer . 

Our nursing essay writing service can provide personalized support to help you succeed in your academic goals.

So, why wait? Contact us to get college essay writing help today! 

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Guest Essay

Nurses Deserve Better. So Do Their Patients.

By Linda H. Aiken

Dr. Aiken is a professor of nursing and sociology and the founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

The Covid-19 pandemic exposed strengths in the nation’s health care system — one of the greatest being our awesome nurses. But it also exposed many weaknesses, foremost among them being chronic nurse understaffing in hospitals , nursing homes and schools .

More nurses died of job-related Covid than any other type of health care worker. The more than 1,140 U.S. nurses who lost their lives in the first year of the pandemic knew the risks to themselves and their families. And yet they stayed in harm’s way. They cared for their fallen co-workers. They went to New York from around the country to fight on the front lines in the first Covid surge. Nurses from Northwell Health in New York returned that support by deploying to the Henry Ford Health System in Detroit in December when a surge occurred there.

We celebrate nurses now. We call them heroes. But if we value their sacrifices and want them to be there when we need them, we must prevent a return to the poor prepandemic working conditions that led to high nurse burnout and turnover rates even before Covid.

As a nurse with extensive clinical experience in hospitals, I found it nearly impossible to guarantee safe, effective and humane care to my patients. And so I established the world’s leading research center on nursing outcomes to understand the causes of nurse understaffing in the United States and abroad and to find solutions to the problem.

The United States has a robust supply of nurses . And there is no evidence that recruits to nursing have been deterred by Covid. To the contrary, applications to nursing schools increased during the pandemic.

Death, Through a Nurse’s Eyes

A short film offering a firsthand perspective of the brutality of the pandemic inside a covid-19 i.c.u..

I was looking through the window of a Covid I.C.U. And that’s when I realized I might see someone die. I didn’t even know who she was. But I was filled with immense grief as she edged closer to death by the hour. What I didn’t know yet was that by the time I left just two days later, at least three patients would be dead. The vaccine offers hope, but the sad truth is that the virus continues its brutal slaughter in I.C.U.s like this one in Phoenix, Ariz. The only people allowed in are health care workers. They’re overworked and underpaid in a deluged hospital. I wanted to know what it is like for them now, after a year of witnessing so much death. Eager to show us their daily reality, two nurses wore cameras so that for the first time we could see the I.C.U. through their eyes. “Unless you’re actually in there, you have no idea. Nobody can ever even imagine what goes on in there.” [MUSIC PLAYING] This I.C.U. contains 11 of the hospital’s sickest Covid patients. Most of them are in their 40s and 50s. And they are all on death’s door. It’s an incredibly depressing place. I blurred the patients faces to protect their privacy. But I also worried that blurring would rob them of their humanity. The family of this patient, the one who is rapidly declining, allowed her face to be shown. And they readily told me about her. Her name is Ana Maria Aragon. She’s a school administrator and a 65-year-old grandmother. Sara Reynolds, the nurse in charge of this I.C.U., organized a video call with Ana’s family to give them a chance to be with her just in case she didn’t make it. “It just breaks my heart when I hear families saying goodbye.” You might expect the doctors to be running the show. But it is really the nurses who are providing the vast majority of the care. “We do everything. We give them baths every night.” “Rubbing lotion on their feet.” “Shave the guys’ faces.” “Cleaning somebody up that had a bowel movement. It doesn’t even register as something gross.” “Look, I walk into the room. I say, hey, sounds like you have Covid. And I might order a chest X-ray. I might order blood work. I might order catheters. All that stuff is done by the nurse. I may have spent 10 minutes. The nurse might spend seven or eight hours actually in the room, caring for them. Let’s say there was a day that nurses didn’t come to the hospital. It’s like, why are you even opening?” “Ibuprofen.” 12-hour-plus shifts, isolated in this windowless room, these nurses survive by taking care of each other. “Aww, thank you.” And by finding small doses of levity. [MUSIC - JAMES BAY, “LET IT GO”] “(SINGING) Wrong. Breeze.” “I’m getting older now, and there’s all these new young nurses coming out. And I feel like a mom to all of them. Morgan, she’s got big aspirations. She loves to snowboard, and she’s so smart. And Deb, Deb’s just— she’s funny.” “I tease her all the time. I can tell her to do anything, and she’ll just do it because I think she’s scared of me because I just always say, make sure you have no wrinkles in those sheets.” The patients spend most of their time on their stomachs because it makes it easier to breathe. But the nurses have to turn them often to prevent pressure sores. There was one woman in her 50s who was so critical that this simple procedure risked killing her. “Even just turning them on their side, their blood pressure will drop. Their oxygen levels will drop.” “Her heart had actually stopped the day before. And so the concern was if it was going to make her heart stop again.” “Then come over. Push.” “We were all watching the monitors.” “I felt relieved like, whew, we did it.” Arizona’s a notoriously anti-mask state. And it faced a huge post-holiday surge in Covid cases. In January, the month I was there, Arizona had the highest rate of Covid in the world. As a result, I.C.U.s like this one have too many patients and not enough nurses. “Because they’re so critical, they need continuous monitoring, sometimes just one nurse to one patient with normally what we have is two patients to one nurse. But there definitely are times when we’re super stretched and have to have a three-to-one assignment.” A nurse shortage has plagued hospitals over the past year. To help, traveler nurses have had to fly into hotspots. Others have been forced out of retirement. Especially strained are poorer hospitals like Valleywise, which serves a low-income, predominantly Latino community. “Many of our patients are uninsured. Some of them have Medicaid, which pays something but unfortunately not enough.” This means they simply can’t compete with wealthier hospitals for nurses. “There is a bidding war. The average nurse here, give or take, makes about $35 an hour. Other hospitals, a short mile or two away, might pay them $100.” “We lost a lot of staff because they took the travel contracts. How can you blame them? It’s sometimes a once-in-a-lifetime opportunity to make a lot of money.” “Every single day I’m off, I get a call or a text. ‘Hey, we desperately need help. We need nurses. Can you come in?’” This nursing shortage isn’t just about numbers. “Physically it’s exhausting. We’re just running. We don’t have time to eat or drink or use the restroom.” “They have kids at home, doing online school. And I think, gosh, they haven’t even been able to check on their kids to see how they’re doing.” “My days off, I spend sleeping half the day because you’re exhausted. And eating because we don’t get to eat here often.” Nurses have been proud to be ranked the most trusted profession in America for nearly two decades. But during Covid, many worry they aren’t able to uphold the standards that earned them such respect. “I can’t give the quality of care that I normally would give.” “It’s absolutely dangerous.” “That’s demoralizing because we care. We’re nurses. It’s our DNA.” Ana had been in the hospital for over a month. Her family told me she was born in Mexico. She came to the States 34 years ago, first working in the fields before eventually landing her dream job in education. She’s beloved at her school. Former students often stop her in town and excitedly shout, Miss Anita. She was very cautious about Covid. She demanded her family always wear a mask and yelled at them to stay home. Yet, tragically, she somehow still caught it. “She had been declining over the course of several days. It’s a picture we have seen far too often that we know, this one is going to be coming soon.” Because there is no cure for Covid, the staff can only do so much. Once all the ventilator settings and the medications are maxed out, keeping a patient alive will only do more harm than good. So Ana’s family was forced to make a tough decision. “And I talked to family and let them know that we have offered her, we have given, we have done everything that we can, there’s nothing more that we can do. The family made the decision to move to comfort care.” “If I’m there while someone’s passing, I always hold their hand. I don’t want somebody to die alone. That’s something that brings me peace.” “Thank you.” “Thank you.” “Dance floor is packed. People hugging, holding hands, and almost no one wearing a face mask.” “I think like many health care workers, I’m angry a lot. And my faith in humanity has dwindled.” “How can you think this isn’t a real thing? How can you think that it’s not a big deal?” “Free your face. Free your face.” Arizona Gov. Doug Ducey has advocated for personal responsibility over mask mandates even though he’s been photographed maskless at a gathering and his son posted a video of a crowded dance party. “Even on the outside, they go, I don’t care. I’m not wearing a mask. I’m not getting the vaccine. That’s bullshit. The second they come into the hospital, they want to be saved. Never do they say, ‘I made the decision. I’m accepting this. Don’t do anything, doctor.’” Half a million people in this country have died from Covid. Many have been in I.C.U.s with nurses, not family members holding patients’ hands. “I always wonder, are they still going to be there when I get to work? It’s on my mind when I get home. Are they going to make it through the night? There’s one that I can think of right now.” One patient in his late 50s was so critical that he required constant supervision. Each of his breaths looked painful. “There was one day that he was kind of— he was looking a little bit better. And so he was able to shake his head and smile. And we set up a video call for him. And it was just the sweetest thing ever. I could hear his little grandson— he was probably 4 years old or so. And I saw him on the screen, too. And he was just jumping up and down, so excited. ‘You’re doing it, Grandpa. You’re doing it. We love you. Look at you. You’re getting better.’ It just broke my heart. It broke my heart. He’s one that I don’t think is going to be there when I get back on Sunday.” But I’d already been told something Sara hadn’t. The patient’s family had decided to take him off life support. “Yesterday they did? Oh. And I just think of his little grandson. And ‘you’re doing it, Grandpa. You’re doing it.’” He wasn’t the only patient who didn’t make it. When I went back to the hospital, I noticed that the bed of the patient I’d seen get flipped over was empty. My heart sank. I knew this meant she’d passed away. “What’s sad is when I go back, those beds will be full. They’ll have somebody else there just as sick with another long stretch of a few weeks ahead of them before it’s time for their family to make that decision.” I’d never before seen someone die. And even though I didn’t know these people, witnessing their deaths left me sleepless, exhausted, and depressed. It’s unfathomable to me that these nurses have gone through that every single week, sometimes every single day for an entire year. I assumed the nurses must block out all the deaths to be able to keep going, but they don’t. They grieve every single one. “I’ve always loved being a nurse. It’s what I’ve always wanted to do. And these last couple months, it’s definitely made me question my career choice.” And what makes their situation so tragic is that many of these nurses hide their trauma, leaving them feeling isolated and alone. “We’re the only ones that know what we’re going through. I don’t really want to tell my family about everything because I don’t want them to feel the same emotions that I feel. I don’t want them to know that I carry that burden when it— that it is a lot. I’m Mom. I’m strong. I can do anything. And I don’t want them to see that.” Leadership in the pandemic hasn’t come from elected officials or spiritual guides but from a group that is underpaid, overworked and considered secondary, even in their own workplaces. As so many others have dropped the ball, nurses have worked tirelessly out of the spotlight to save lives, often showing more concern for their patients than for themselves. I worry their trauma will persist long after we re-emerge from hibernation. Covid’s legacy will include a mass PTSD on a scale not felt since World War II. This burden should not be ignored. “Thank you. Thank you. I feel, yeah. And you’re all amazing.” [MUSIC PLAYING]

Nevertheless, we find ourselves too often with a shortage of nursing care. Many decades of research reveal two major reasons: First, poor working conditions, including not enough permanent employer-funded positions for nurses in hospitals, nursing homes and schools. And second, the failure of states to enact policies that establish and enforce safe nurse staffing; enable nurses to practice where they are needed, which is often across state borders; and modernize nurse licensing rules so that nurses can use their full education and expertise.

Training more nurses cannot solve these problems. But more responsible management practices in health care, along with better state policies, could.

Not only are states not requiring safe nurse staffing, but individuals also do not have the information and tools they need to pick hospitals and nursing homes based on nurse staffing or to advocate better staffing at their hospitals and nursing homes.

Ninety percent of the public in a recent Harris Poll agreed that hospitals and nursing homes should be required to meet safe nurse staffing standards. But powerful industry stakeholders — such as hospital and nursing home organizations and, often, medical societies — are strongly opposed and usually defeat legislation.

The New York State Legislature is the first in the postpandemic era to fail to approve proposed safe nurse staffing standards for hospitals. The legislature passed a bill that did not require safe nursing ratios, opting instead for internal committees at hospitals to oversee nursing and patient safety. This happened despite compelling evidence that the legislation would have resulted in more than 4,370 fewer deaths and saved more than $720 million over a two-year study period through shorter hospital stays.

What are the solutions? While there are some actions the federal government could take, the states have most of the power because of their licensing authority over occupations and facilities. The hospital and nursing home industries have long failed to police their members to remove the risk of nurse understaffing. So states should set meaningful safe nurse staffing standards, following the example of California, where hospital nurses cannot care for more than five adult patients at a time outside of intensive care. State policies are tremendously influential in health care delivery and deserve greater public attention and advocacy, as they are also ripe for exploitation by special interests.

In states with restrictive nurse licensing rules, many governors used their emergency powers during Covid surges to waive restrictions. If they were not needed during a national medical emergency, why are they needed at all?

Still, the federal government has a role to play: It should require hospitals to report patient-to-nurse staffing ratios on the Medicare Hospital Compare website, because transparency motivates improvement. The federal government could incentivize the states to pass model nurse practice acts.

We need influential champions taking on special interests so that states will make policy changes that are in the public’s interest. AARP is using its clout to advocate nurse-friendly policies. But health insurers and companies such as CVS, Walgreens and Walmart that provide health care have been on the sidelines.

While we long to go back to pre-Covid life, returning to chronic nurse understaffing in hospitals, nursing homes and schools would be a big mistake. We owe nurses and ourselves better health care resources. The so-called nurse shortage has become an excuse for not doing more to make health care safe, effective and patient-centered. State legislators must do their job. Health care leaders must fund enough positions for nurses and create reasonable working conditions so that nurses will be there to care for us all.

Linda H. Aiken is a professor of nursing and sociology and the founding director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

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An earlier version of this article misstated the status of legislation on nurse staffing standards in New York State. The bill passed without setting minimum nursing ratios; it did not fail to pass.

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Approaching Death

A nurse goes from the er to a hospice, and changes the way she thinks about life and its end..

Illustration by Robert Neubecker.

This essay originally appeared in I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse , a collection edited by Lee Gutkind, out now from In Fact Books.

A child is dead.

There is a terrifying, soul-piercing scream that a mother makes when she loses a child. This scream is so universal that everyone, in every corner of the emergency department, knows what has just happened when they hear it.

On a sunny summer morning, a young mother of a 3-year-old watched, stunned by ultimate dread, as her little boy ran out into the normally quiet street. On that day, however, the driver of a rainbow-painted Volkswagen bus careened through the neighborhood; 20 minutes later the mother stood in our trauma room, looking as if she might collapse. She told us, through tears and broken English, how she had heard the screech of tires, the crumpling thud. She ran into the street, knelt down to her son, and gathered the little boy into her arms.

It may have been clear to the paramedics, when they arrived, that this child had no life left in him, yet they knew to move with the kind of energy that infuses hope into impossible situations. They did everything in their power—oxygen, monitors, IVs—an all-out resuscitative effort. It is hard to imagine anything worse for a parent than to watch an aggressive attempt at her child’s resuscitation. Except, I suppose, to see no effort at all.

The little, broken body was transported to our emergency room, and we put on a similar show—a collective swoop of doctors and nurses and technicians. We focused the exam lights on him and looked, listened, strained to detect some tiny morsel of life with which to run; it’s not just for the benefit of the parents that we go all out, even when mottling has set in. We, too, need this cathartic effort in order to begin to grieve. Seeing a child die is never easy.

Years ago, it was customary to keep families out of the room when a crisis was in progress. But nowadays we know that one last look, one more moment of hope can be vitally important to the process of saying goodbye. The mother, looking stricken and white, stood by the door and held onto the arm of a nurse. When the initial moments had passed, the chaotic energy in the room suddenly changed. The doctor lowered his voice and called the time.

And so, the scream.

I left the room to find the father in the waiting room down the hall. I paused at the door before entering, wanting to wait as long as possible before destroying his world. He took one look at my face and fell to his knees, his forehead slapping onto the scuffed white floor. I waited while he groaned to his feet, then led him to his wife and dead child. So the parents could sit with the little boy, the team had tried to clean him up and had pulled the tube from his nose. I motioned the father into the room and left them alone to say their goodbyes. I had to rush to the next emergency.

Courtesy of In Fact Books

That was the moment when my edges began to wither and I felt a hardness creeping in. Was it really possible that my response to the intense anguish of two broken parents was to push them into a room and run off to finish my job? When had I become so callous? I remembered myself as a new nurse—one who made it a point to touch every patient, even when she wasn’t examining them; who had a gift for sensing what a psychotic patient needed in order to de-escalate; who was known as the one to call when a battered woman needed to feel safe enough to talk—but this memory was distant and faded.

I was overly sensitive, even as a child, to the suffering of others. When I watched Westerns, I would get teary when the cowboys yanked at the mouths of their horses. “Think about how lucky those horses are,” my father had said, trying to console me. “They get to run all day.” I became so upset when I read Black Beauty that I hid in my room and cried for hours. I know the story has a happy ending only from secondhand accounts as I’ve never been able to bring myself to finish it. In the fourth grade, I jokingly pulled the chair out from behind a shy and quiet classmate, the way I had seen it done on The Three Stooges . The boy fell and hurt his back, and I was so distraught over his tears that I never spoke to him again. While working in a bookstore, years later, I happened to glance through the pages of an autobiography written by a man who had been viciously abused as a child. I went home sick that day because I simply couldn’t function with those pictures in my head.

How does someone with these pathological, debilitating reactions to distress function in a world of endless pain and struggle? Easy. Build walls and stay busy.

I had been involved in emergency medicine for 14 years—first as an emergency medical technician, then as a paramedic, and finally as a nurse. The crackling energy and hot, white lights of the ER seemed like a perfect fit for my frenetic nature. I’d always had enormous reserves of energy; reading was the only thing that ever slowed my racing thoughts, and my mother would hand me a book the way another might hand her child a lollipop. So, there I was, a center stage participant in a vital dance, and the result was a matter of life and death. I felt completely at ease. When I speed-walked down the halls, I often heard the joke, “Where’s the fire?” There were never charts waiting on the desk when I was working, and my inability to sit still, or to even slow down, lessened the workload for everyone as I zipped through the incidentals, the standard protocols, the well-worn paths of action. Everyone around me thought I was doing a great job.

But nonstop motion is not always as productive as it seems—the best emergency workers, in fact, move slowly, carefully. I eventually realized I was missing something. I felt like I was floating through someone else’s life, as if I wasn’t actually feeling compassion. I felt like a fraud.

I went to nursing school partly because I liked being the one whom people looked to and leaned on in times of crisis. Like many people I met in emergency medicine, I had the proverbial need to be needed. I took pride in caring for my patients, but my urgency to be in the next moment prevented me from really seeing them. My co-workers liked to work with me, of course, and my employers thought I was excelling. But what about the patients? I didn’t know how to find my buried compassion, nor did I know what to do next. But I knew the time had come to move on.

The ability to change specialties is one of the best aspects of nursing. I assumed, because I had seen so much, because my critical care skills were the envy of some physicians, and because I knew exactly how to react in the direst of situations, that I was qualified to do anything. I had seen things most people would never see, having been at the center of a pounding, bloody battle where we won as often as we lost. I needed something completely different. Of course, any other type of nursing would be, if not a step down, at least less challenging. I walked around a job fair, aimless and uncertain, until I found myself standing in front of a hospice booth.

I had been, in my childhood, a distant witness to several deaths. When my great-grandfather died, I watched my mom cry and was sad he would never finish teaching me to play pinochle. I was heartbroken for my friend when her mother died, and I cried and cried when a car hit my golden retriever. But I was never afraid. This is not to say that I was evolved or anything. When I was 13 years old and square in the middle of that most awkward, terrifying slice of adolescence, I actually looked forward to death. Perhaps it was a brief, pathological, adolescent-induced depression that made me wish for it. As I matured, however, the feeling that death was a lovely way out stayed with me. Nothing could ever get me really down, or be too serious, because I would eventually die. It may sound like a strange consolation, but I had become quite comfortable with my old friend, Death.

Maybe hospice would be the fit I was searching for. During my first month of the new job, I agreed to work the weekend on-call shift. Two 12-hour days of nonstop calls took me from one end of the spectrum to the other: reinsert a urinary catheter, teach a family what CPR really entails, hold a child’s hand as his mother takes her final breaths. I constantly switched gears, depending on where a particular patient or family happened to fall on the timeline of life and death. Caring for the dying, as well as their families, I hardly noticed that I had somehow chosen the one shift in hospice that fit my old profile.

Over one weekend, I ordered antibiotics for a 98-year-old woman who lived alone and refused help with anything, comforted a woman who had to place her elderly husband in a nursing home against his will, and started an IV on a young woman who insisted she was not ready to die, though every system in her body was decaying from cancer. I spent two hours talking a wildly delirious patient into allowing his wife to give him his meds; I ran back to the office for supplies, twice; and I spent several hours with family members as they waited for the mortuary to pick up their matriarch.

It was five o’clock on a crisp, chilly Sunday evening when my pager beeped again: “Six-week-old patient in crisis.”

A tiny flaw in the genetic makeup of a developing human can result in a life just incomplete enough—after nine months of gestating, 16 hours of birthing, and a few hours of bonding—to be afflicted with multiple congenital anomalies. “Take him home,” the doctors said, “and hospice will help you keep him comfortable. We are probably talking about weeks.”

The baby would suffer from longer and longer periods of status epilepticus, and drugs would become less and less effective. His tiny frame would flail in violent, disorganized muscle contractions 10, 15, 20 times a day. The hospice team—a nurse, a social worker, a chaplain, and a CNA—visited the parents every day to comfort them, to teach them to care for him, and to support their grieving process. The family had gotten to know this team, but I was the nurse on call that day.

Thirty minutes after I got the page, I drove up a bumpy dirt road to a little green house on the side of a mountain. The neighborhood was quiet, private, and filled with golden aspens changing colors for the season. The door opened before I knocked. The father’s eyes were teary, and his parchment skin looked drained and hollow. He led me silently through a hallway, one entire wall of which was covered with books—perhaps the ones they had hoped their son would read. The mother was sitting in a rocking chair, holding her seizing infant. “It hasn’t stopped for twelve minutes.”

All I could do for him, for them, was be calm and present as this tiny creature worked his way toward the end we all come to. My heart broke for them, but I stood by and fought the urge to rush in. I couldn’t intrude on this precious process. I waited with them, moving only to help with positioning or to offer gentle suggestions. In the air, I felt his tiny presence slip away, slowly and peacefully. He stopped moving, his breathing slowed until it was imperceptible, and for a moment his complete stillness made me hold my own breath. I reached for the pediatric stethoscope around my neck, warming it in my hand so as not to startle him. As I pressed it against his chest, his mother said, “His name is Christopher.”

“Hi, Christopher,” I whispered as I listened.

I didn’t need to say the words. I knew from her expression that she knew. A slow, fat tear dripped down her face, and I backed away, just far enough out of the picture, in my attempt not to invade this moment of goodbye between the three of them. There was nothing for me to do but be still. I crept back, found a chair, and sat to wait.

And then I began to sob.

I felt myself losing control, choking and sobbing as if he were my child, my loss. I didn’t even have children. I tried not to make noise, tried not to trespass on their moment. I was so ashamed! I was supposed to be their support, their rock. I moved to quietly slip out of the room, but I felt the husband’s hand on my shoulder. His eyes were wet and kind. He handed me a tissue.

I couldn’t believe what a failure I was.

I got it together, finally, and helped them decide what to do. I called the physician, the coroner, and the mortuary. At the mother’s request, I got permission from the mortuary for the couple to drive the tiny body themselves. I helped them into the car by holding the baby, who now had a little blue cap on his head, while his mother settled herself in the passenger’s seat. I placed Christopher on her lap, hoping they wouldn’t get pulled over and have to explain why their baby was not in a car seat.

I was watching them ease down the driveway when the car suddenly stopped. The mother gently handed her little bundle over to her husband and got out of the car. Before I could react, she’d wrapped her arms around me. I was so stunned by the gentle, intimate comfort she offered that I barely moved. She finally let me go, looked at me, then got back into the car. They drove off. As I watched them go, I wondered if maybe I hadn’t failed. I hadn’t swallowed my grief. I hadn’t patronized them or tried to explain “the process.” I had been absolutely present with them in that agonizing, priceless moment. It was the best I could do.

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The Meaning of Cna's Experiences in The Nursing Home

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Published: Jul 30, 2019

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