Everything Nurses and CNAs Need to Know about Working at a Skilled Nursing Facility (SNF)

9 min read

As a big part of the population continues to age, job opportunities at skilled nursing facilities (SNFs) continue to rise. According to the US Census Bureau, by 2030 all baby-boomers will be older than 65. Because of this, the aging-in-place movement is also gaining traction, yet many elderly people will find that aging at home is not a viable option.

If your goal is to make an impact and help people during their toughest times, SNFs–also known as nursing homes– will benefit from your contributions. Working at an SNF means you’ll be caring for patients who are at some of the most vulnerable points in their lives, some without any family members who live close by.

Differences between SNFs and Hospitals

Nursing homes often have a higher percentage in patient-to-nurse ratios, usually around 15-1, due to the patients being more medically stable. Staffing formulas rely on a number of LPNs and nursing aides to assist these patients with bathing, toileting, and feeding.

Even so, as hospital stays tend to grow shorter, patients who are sent to SNFs may still require PICC lines, ostomies, infectious diseases, or wounds that need constant monitoring and attention.

With the higher patient-to-nurse ratios, time management skills and efficiency are essential when working at an SNF. There is also paperwork and documentation that needs to be handled, and times when you’ll need to update family members as well.

Because the inpatient population doesn’t turn over as quickly as in hospitals, you’ll form close bonds with patients and their families. Sharing birthdays and other celebrations, along with helping patients with personal milestones is common. You’ll also achieve a comfort zone with some of your patients, enabling you to intuit their needs. This makes you capable of delivering an exceptionally high standard of care.

In an acute hospital, patients tend to turn over fairly quickly, which makes it tough for you to build a strong bond and understanding with your patients.

Additionally, your pharmacology skills and knowledge will also vastly improve, as you’ll be the one charge of handing out the medication on a long-term basis. You’ll also be watching for any possible troublesome effects that develop over time, as well as any problematic drug effects and dosing errors.

This variety of responsibilities makes SNFs a great entry-level position for newly graduated nurses because you’ll learn how to wear multiple hats while developing your time management skills.

Certified Nursing Assistants in SNFs

The role of a certified nursing assistant (CNA) is to provide basic care for patients, as well as assist in daily activities they may have trouble doing on their own, such as bathing. Due to the personal nature of this job, a CNA must have people skills and compassion, as well a sincere desire to help others. After all, CNAs are the patient’s main caregiver.

A CNA will also work with the latest medical technology, such as billing software, health information software, and medical record charting software. In certain facilities, a CNA will also administer medication, but this usually depends on the CNA’s level of training and experience, along with state regulations.

CNAs report to either a registered nurse or licensed practical or licensed vocational nurses. They should be skilled in communication, as they will report all patient concerns and issues to their supervisor.

Due to the increasing age population, the role of a certified nursing assistant has become even more necessary. Those interested in working as a CNA for an extended period of time may find an SNF to be a great fit. According to dataprovided by the National Network of Career Nursing Assistants, over 28% of CNAs stay for up to five or more years in their role and almost 13% stay up to 10-55 years.

Benefits of working in a nursing home or a long-term care facility include the relationships you’ll make with patients and job security. But keep in mind, the US Bureau of Labor Statistics (BLS) Occupational Outlook Handbook notes that many nursing assistants go on to further training or a new job because of the emotional and physical toll.

Differences between SNFs and Hospitals for the CNA

While the tasks are usually the same, CNAs in a hospital won’t spend as much time with their patients as they do at an SNF, due to higher patient turnover in hospitals.

While both are considered to be fast-paced environments to be working in, a hospital setting will offer a CNA the chance to work in different departments. In a hospital setting, CNAs also might be a “sitter.” These are roles for CNAs to monitor and help patients who need full attention. For example, a patient might be confused due to a medical condition and pull out their IV. A “sitters” ensures that this patient doesn’t touch their IV line.

Most patients at SNFs don’t require a sitter to watch them, as they tend to be more stable.

Rehab Centers for CNAs

A CNA’s responsibilities while working at a Rehab Center are quite similar to that of a SNF, although with some minor differences.

Responsibilities may encompass bathing, dressing and feeding the patients. CNAs will also assist with the patients rehabilitation plan. This may include assisting in transfers, walking and other physical, speech or occupational therapy activities as established by the therapist.

One of the key differences between SNF and long term rehabs is that rehabs tend to have patients that are way more stable. They require less attention but may require more help such as feeding and helping with the toilet.

CNA Salary

There is a projected need for 393,000 CNAs needed in the United States by 2016. CNAs are one of the most in-demand professions in America, but with so many job offers, which of these locations should you work at?

Top 10 Best Paying States for CNAs

State Salary (hourly)
1. Alaska $14.36
2. New York $13.63
3. Connecticut $13.54
4. Massachusetts $12.77
5. Hawaii $12.53
6. District of Columbia $12.47
7. Maryland $12.47
8. Delaware $12.32
9. New Hampshire $12.24
10. Nevada $12.23

Registered Nurse (RN)

Unlike LPNs and CNA who are limited by the kinds of the task they can perform, RNs are capable of performing much more complex or invasive treatment. For instance, they administer medications and injections, take blood, and prepare to insert IV lines. They also monitor each patient’s health and progress by evaluating their vital signs and assessing other indications of their physical and mental well-being.

Furthermore, they determine the treatment plan for each patient and ensure the care strategy addresses the long-term needs of the aging patient and the condition in which they are coping.

Due to federal law, a skilled SNF must have at least one RN present for up to eight hours a day. Usually, a single RN will be on duty at a time, and they’ll frequently supervise LPNs, CNAs and other direct care support staff. They also ensure patients receive ongoing care during shift changes. The RN will also have more training and experience under their belt compared to other employees and may hold the title of head nurse or director of nursing. This a similar role to that of a hospital charge nurse or nurse manager, delegating a task, assigning employees to specific patients and monitoring the overall quality of the home.

Besides directing bedside care, RNs at skilled nursing facilities also act as patient advocates and educators. They will teach both the patient and family members of what they should expect when it comes to dealing with the challenges of aging or specific conditions the patient has and help them better understand what they can do to help the recovery progress and long-term wellness.

They are also capable of informing family members of any changes that may occur in the patient’s condition and corner with them regarding any changes that can be done to the patient’s medication or other needed treatment. Furthermore, they work closely with the facility’s resident physician in order to come up with a care plan to implement and to notify them if the patient’s condition improves or deteriorates.

RN Salary

The average salary of Rn by the state provided by the U.S. Bureau of Labor Statistics.

Licensed Vocational Nurse

When it comes down to job responsibilities, a RN and LVN duties are quite closely the same for a patient’s care. Although, there are still some major differences. For example, one of the major things that separate the two careers is that while RNs tend to work independently in a variety of areas. LVN is required to do so under the supervision of either a doctor or RN.

The duties of a Licensed vocational nurse working at a skilled nursing facility include providing patients with basic nursing and medical care, such as inserting catheters changing bandages and check their blood pressure.

Making an effort to make the patient as comfortable as possible, and bathing plus dressing the patient. They are also to talk to the patient about their health to see if they are experiencing any sort of discomfort that may need to be addressed.

Keeping records on the patients, and reporting on how they are doing to the RN manning the facility. Lastly, LVN are capable of supervising and managing any fellow LVNs or medical staff that are currently unlicensed.

LVN Salary

The Bureau of Labor Statistics (BLS) states that in 2017, the median annual income for LVNs was $45,030, or $$21.65 an hour.

Here a list of highest paying from each state provided by the BLS.

Day in the life

Now that you have a clear vision of what it is to be working as a CNA, RN, and LVN at a SNF, let’s go over a typical day in life working at a SNF.

 Waking up

Many daytime nursing shifts being early, usually at 7 am. Breakfast, shower and any other morning activity will be happening much earlier compared to others.

The good thing about working as a CNA, RN, and LVN is that you can choose to work either during the day shift, mid shift, or graveyard shift. It’s quite flexible even for SNFs.

It’s 8:00 AM as you walk in the night nurses team should be leaving as the day nurses start walking in, usually it starts with a daily handoff of information at the start of every shift. The day nurse will get the intel on what happened during the night if patients are in need of something specific, or anything else a nurse needs to know about their patients. On a typical day you may see up to 7-8 patients a day with 1 to 3 evals.

There’s also a chance you’ll need to check supplies and inventory as well, to make sure they have enough for this shift. Everything a nurse does for a patient must be noted down, update and charted right away.

Your tasks will vary depending on the role you hold at the SNF. For example, nurses are responsible to making sure the patient is ok and making any changes that needs to be made during the day. Whereas a CNA would most likely be responsible for helping the patients take their morning showers, moving from the bed to the chair for breakfast etc.

Morning Rounds

Do your rounds to check on patients and assist with bathing, dressing, grooming and other personal care tasks if required.Once breakfast is done patients will normally go to a gym with specialized equipment where each one will work with a therapist.


During lunchtime, patients will usually have a chance to talk. They also have options for eating in their rooms if they want privacy or with a family member. Lunchtime for nurses isn’t set in stone. Obviously eating lunch is necessary if you want to keep up your energy, but having the time to do so can quite difficult to get them. Typically most nurses either bring their own meal from home or grab a quick bite from a nearby restaurant.



Therapy session tends to continue after lunch for most patients. Nurses also continue to make their rounds once again to ensure their patient’s health hasn’t changed much since the morning.  Depending on their level of recovery and overall health condition, patients can take part in scheduled activities and excursions designed to promote socialization and mental well-being.


Evenings and dinner time are often spent relaxing or with visiting family and friends, once again. Patients are also allowed to move around to socialize and will typically play some card games among each other. Nurses will continue to see any patients and review their charts while update any collected data. Some nurses may even review the schedule for the next following day.

Afterward its back home to bed and rest for another day.

Do note that the busiest times for nurses and CNA are the mornings. This is when patients need to get their daily routine done such as eating, bathing, and going to the toilet.

Pros and Con of working at a SNF

As with any other occupation out there, all sorts of pros and cons come with working at a skilled nursing facility. Here are some ups and downs for working at a SNF:


1. Get to know your patient

Working at a nursing home will offer you the opportunity to foster a relationship with long-term residents more so than would be possible with an outpatient or at a hospital setting.


Most residents at SNFs will be there for a while, so you’ll have the chance to build close relationships with the patients.

2. Sharpen your pharmacology skills

Handing out medications will be quite common at a nursing home. Your pharmacology skills will be further refined than most, due to having to keep watch of the dosage you’ll be handing out to each patient under your care.

As a LVN, you’ll be spending a good amount of your day passing out meds. This is a typical routine. As a CNA, you’ll be in charge or ensuring that the patient takes the medications.

3. Work as a team

Your team will consist of all sorts of different people from various backgrounds and occupation. Regardless of every single one of you will be working together for the good of the patient. This kind of camaraderie is rather unique and makes the stressful days easier to handle.

4. Experience variety

All types of diagnoses will be seen at nursing homes mostly due to it being a generalized internal medicine unit. These type of diversity means you’ll be witnessing something different each passing day.

5. less physically demanding

You’ll most likely be spending a ton of time on your feet each day, but working at a nursing home is typically less physically demanding than other nursing places.

As the old saying goes, there are two sides to every coin. With the interesting benefits given to you so do some few drawbacks when it comes to working at a nursing home. Here are some cons that you should be aware of.


1. Getting attached to patients

One of the many downsides of establishing a close relationship with your patients. This will inevitably lead to you developing a favorite resident or two because of how easy it is to get attached to these people. Whenever the resident’s health declines, it can be really hard for most to deal with.

2. Stigma about nursing homes in general

While the nursing home may seem like a wonderful place to be, others may not share the same opinion as you. Overcoming these misconceptions is something that you’ll likely learn to handle on a regular basis.

3. Skills are more concentrated

Nursing homes will offer little change to practice EKGs, responding to medical codes, starting IVs, drawing cultures and blood tests, calculating medication drips or starting A-lines. So if your trying to hone these skills then a nursing home may not be the best environment for you.

Resources for finding a SNF


If your the type of person who enjoys working with the elderly and developing close relationships with patients, a career in skilled nursing facilities may be the option for you. You might even see yourself earning certification for a higher position in the field of nursing in doing so. Even so, this job may not be for everyone, it does take a special person to be capable of taking care of vulnerable patients during their final years.

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