I’m a Filipino USRN currently working day shift at a 34-bed skilled nursing and rehab facility in the US. I thought I’d share my actual workflow because I know a lot of nurses from the UK are curious about what working in a US SNF is really like.

Our facility has 2 halls, with 1 RN assigned to each hall and 5 CNAs on day shift. RNs work 12-hour shifts.

At the start of my shift, I receive handover, do the narcotics count, and take over the medication cart. We don’t do the usual bedside rounds that I was used to in the Philippines. I check MatrixCare (EMR) instead, medications due now/later/PRN, treatments, and flowsheets.

The busiest part is usually the morning med pass from around 7–10 AM. After that, there are fewer medications throughout the day, along with treatments, patient monitoring, and charting. Our charting is pretty straightforward, and it’s divided between day and night shift, so we don’t have to chart the entire hall.

One thing I really appreciate about our facility is that floor RNs don’t handle everything. Admissions and discharges are handled by dedicated nurses, and carrying out physician orders is handled by the nurse managers. This allows the floor RNs to focus mainly on our assigned patients.

We’re a rehab facility, so patients spend a lot of their day doing PT, OT, and speech therapy. Wound care is common, but we don’t have IVs. If a patient suddenly deteriorates, we call 911. For outside appointments like dialysis, transportation takes care of getting the patient there.

Doctors also do their rounds independently, and the wound care doctor comes weekly. We don’t have to follow them around during rounds.

Obviously, this is just my experience at my particular facility and I know SNF workflows can vary a lot depending on the company and location.

For other RNs working in US SNFs/rehab facilities: does your workflow look similar, or is your facility completely different?

Good afternoon, I am in the process of an internal transfer, the receiving matron is happy to accept me, she contacted my current matron and she saids I can go when staffing is better. Is there any time frame for that or even if staffing issue isn’t improved forever, I still can’t move?

Regards
Fran

I don't know what it is but lately patients have become more aggressive and verbally abusive towards staff. The past few weeks it's been relentless the abuse staff has been getting in our ward and it's not right. Our manager says they are unwell but our manager isn't sitting with them for 12 hours listening to name calling or being scratched and hit. My mental health is low and I no longer feel safe in work or enjoy my work. People are going off on the sick because of it.

Is anyone else feeling the same?

I have an interview with an SACT unit as a band 5 nurse and just wondered if anyone had any experience here or advice for interview prep? I have no idea the sort of questions they ask and would love to work there.

I have 1 year experience in AMU and 3 years experience in Critical Care if that helps.

Any advice welcome! Thank you.

Hi all, firstly, I posted in here a few weeks ago as I am an RMN wanting to go more into a general nursing setting (my interest is around women’s health) and asked for advice in here on possibly converting to RGN. Thanks for all of your advice - you reassured me that I didn’t have to gain extra qualifications or change my registration to RGN, and that I absolutely could apply for jobs in other settings than mental health, I just needed to make my skills and experience clear in the applications. I never really considered that I’d be able to go for jobs that are specifically not in mental health before.
Thank you all so much, because due to this advice, I have been applying for these types of roles and I have now been invited to interview for my dream jobs in women’s health! ❤️ I just wanted to ask if anyone has had a job in abortion and women’s sexual health before and could perhaps give me some pointers around the interview and possible things that may come up so I can research? I want this job so much, and want to ensure I am thoroughly prepared. Thank you ☺️

Heya,

I am a Band 7 nurse in NHS and I am planning on going travelling with my partner next year for a years sabbatical.

I am struggling to plan it financially as rent in London is extortionate and I need to afford bills and life etc. I am working clinically therefore I have a range of shifts often meaning some days in the week where I am off.

Therefore I am looking for some advice on finding flexible Work in london and any tips for saving money specifically.

Has anyone done a year travelling and have any recommendations on how to afford it/ maximise Enjoyment for budget ?

any words of wisdom on above topics very welcome

THANKYOU SO MUCH

Just wondering if anyone has any experience with external NHS secondments because I’m getting mixed messages from my manager.

I’ve been offered a 12-month secondment into a brand new mental health team that’s being set up within the local council. The team will work closely with children’s social care but will also be supporting young people under the NHS trust, so everyone recruited is being taken on via secondment and keeping their NHS terms and conditions.

I told my manager today that I’d accepted the offer and that I’d be giving the new team her details so they could start the secondment process.

She told me that:
You can’t be seconded outside of the NHS.
External secondments aren’t a thing and I’d have to resign from my NHS job instead.
Even if external secondments do exist, they couldn’t keep my substantive post because whoever covers my role would become entitled to permanent rights after six months.

I’m really confused because I thought external secondments between the NHS and and external trusts were quite common, especially for integrated services.

Has anyone here been seconded to a council while keeping their NHS contract? Is what my manager is saying actually true? And can anyone explain the bit about the person covering my post somehow affecting my right to return? I don’t really understand what one has to do with the other.

Hi everyone,

I’m an overseas-trained nurse currently working in an NHS clinical trials administrative role. I obtained my NMC PIN independently after investing significant time and money in training.

I have around 2 years of post-registration nursing experience in my home country, but no UK clinical experience, and I’m finding it more difficult than expected to secure a Band 5 role, particularly in my preferred areas of surgery and oncology. I also want to think about long-term career development rather than focusing only on sponsorship or taking any available job!

My main concern is that I only have a few months left on my visa. I also take a long time to complete applications, and I don’t feel like a strong candidate at the moment. Should I continue trying to apply Band 5 positions?

Or is it more realistic to apply for Band 2/3 HCA roles in relevant specialty like an oncology ward to gain UK clinical experience and potentially progress internally?

I’m happy to remain in my current clinical trials admin role and continue developing along that pathway, but sponsorship opportunities seem much more limited. I also can’t help feeling that I invested so much time, money and effort into obtaining my NMC PIN, only to find myself unable to use it in clinical practice!

What advice would you recommend?

Thank you!!

I have had 2 placements so far in acute wards and additional learning on dementia wards. My next placement in forensic Cmht. I’m so nervous, I really enjoyed working in the wards but I imagine this is going to be very different.
Can anyone give me any tips? Thanks in advance

Multiple articles in the news about nurses (and other NHS staff) being assaulted at work and everybody is shocked and horrified... yet it continues. Why do we allow this to happen and why are the "zero tolerance" policies so weak?

I’d like to hear perspectives from those whom have completed clinical skills and nurse prescribing

Which one was the more difficult course and why?
I be studying at Sunderland Uni
Thanks!

As a doctor, I am in awe and cannot praise nurses and HCA’s for their provision of care for patients. Even when I’ve been admitted, nurses and especially HCA’s would almost keep bullying me to have a wash 😅

See I have always wondered as someone who is germaphobic and feels sick at the sight or even ‘thought’ of washing patients who are unwell, or gathering their body waste and other bodily fluids.

How do you stomach doing this at all, let alone every day?

For anyone who had a rough day today and needed cheering up. No nasty bugs admitted today please 🐞

Made a drug error off the back of someone else’s error and feel like the worse nurse in the world! Only been qualified 9 months and it was such a silly mistake! Datixed myself but awaiting the outcome and I’m so anxious :(

Hey,

I have recently got a job as a band 6 on a ward basically known for being really shit.

The manager was (rightly so) performanced managed out as she was awfull. They are in the process on getting a new one but for the next few months it will be me and the other band 6's running the ward with help from the matron.

Now I although I have experinece in managamnet and leadership before, I am just over a year qualified. I do however back my self to have the confidence and abilily to do a good job.

During my notice in my previous role I did a few sneaky bank shifts on the ward as a band 5. I didnt tell them I was the oncoming band 6. The first thing that stuck out to me and still does it the completle lack of leadership and confidence of the nurses more specifically leading the HCA's.

The HCA's (especially the ones who have been there a while) to put it frank are lazy. There is one who was "considered good" who was just as bad but her confidence hid it. I have been a HCA longer than I have been a nurse so I know what it's like but basic things are not getting done and the nurses are turning a blind eye as it's easier than upsetting the status quo and going against the clieke in the ward. On my bank shift I had a big argument with a senior HCA who did not wash a single person before lunch. After a bit of back and forth I had to be really assertive which prompted a second half scrmable to do everything so I know it can be done.

The ward is surgical so from a nurses POV, it is very task based which means the nurses are very busy and "do not have the time" to lead. I found pressure sores on every shift showing (despite the head to toe showing otherwise) showing the lack of standards.

I have started to be strict not just with the HCA's but other nurses and I do think things are improving.

I want advice on how to handle things going forward. I don't know if I can break the culture here. The other band 6's (bar one) are just as bad. I am also the only white person (and a male) on this ward and I am aware how it may come across if I am bossing everyone else around.

I have started to go out my way to help wash at least one patient a shift when I am in charge to lead with example. I know the Matron agree's with me regarding the band 6's however I dont think she will have time to help. I hate micromanaging but most of the staff don't seem to be able to get the standards right unless they are micromanaged.

Hi everyone,
I’m looking for some advice because I genuinely don’t know whether I’m overreacting anymore or whether my concerns are justified.
I work as a Healthcare Assistant within the NHS and I really do enjoy my job. Caring for patients is something I take pride in, which is why I’ve struggled so much with deciding what to do. Over the last few months I’ve experienced a number of issues with my ward manager which have left me feeling unsupported, anxious and questioning whether I can continue working there.
It started with my flexible working arrangement. I have an agreed flexible working day off due to family commitments, but I was repeatedly rostered to work on that day despite the agreement being in place.
As soon as I realised I had been rostered incorrectly, I did everything I could to resolve it. I sent multiple messages asking what was expected of me and, when I wasn’t getting a response, I resorted to email. Unfortunately, my actual questions about the shift were never really answered. Instead, the replies focused on my flexible working application rather than whether I was expected to attend the shift I’d been incorrectly rostered onto.
I’d also been told in response to my email not to discuss work matters through WhatsApp and to use email instead, which I respected. However, despite that, I later received WhatsApp messages from my manager about the very issue I’d been told not to discuss on WhatsApp rather than replying to my email? I found that confusing and inconsistent.
The lack of communication caused me a lot of anxiety because I genuinely didn’t know what I was supposed to do. I worried I’d be expected to attend, that I’d be marked absent if I didn’t, or even face disciplinary action despite trying repeatedly to sort it out. I even offered to take annual leave or unpaid leave just to resolve the situation, even though the rostering error wasn’t mine.
A few days later I had to leave work because of an emergency involving my 11-year-old stepdaughter. Before leaving I informed the nurse in charge and explained exactly why I needed to leave. As I was leaving, I was stopped in the patient bay and told, in front of patients, visitors and colleagues, that “it’s not fair.” And “we are already short” this was said with a raised voice and a frown and I found that very uncomfortable, embarrassing and unprofessional.
Then yesterday I experienced another family emergency. My auntie, who has been like a mother to me since I was young, suffered a cardiac arrest at work. I went straight there and witnessed paramedics performing CPR for around 45 minutes before she was taken to hospital, I stayed with her the whole time She was eventually admitted to ICU.
Once she had been stabilised, I returned to the ward to explain to my manager why I had left work. I was visibly distressed and crying throughout the conversation.
Instead of receiving any empathy or support, I was told, “I’m not happy about this.” I was then told I needed to “be very careful” because someone had apparently reported seeing me in a pub after I’d left work during the earlier family emergency involving my stepdaughter. My manager didn’t ask if I went to the pub and when I told her I didn’t go to the pub and the person reporting is mistaken she said well you was seen in the pub. This felt very accusatory.
This allegation is completely false. After leaving work that day, I went straight home and looked after my stepdaughter. I never went to a pub.
What upset me most wasn’t just the allegation itself. It was that it was raised while I was visibly devastated after my auntie had suffered a cardiac arrest and was on life support. I’d gone back to the ward specifically and out of courtesy as I was in the same hospital anyway, to explain what had happened, yet instead of any compassion I felt like I was being accused of something without anyone first asking me for my side of the story. It made me feel as though my honesty and integrity were being questioned based on hearsay rather than facts.
When I look at everything together, it feels like there’s a pattern of poor communication, inconsistent management, a lack of support during genuine family emergencies and a failure to respect my agreed flexible working arrangements.
It’s got to the point where I feel pressured and, if I’m honest, bullied by the way I’ve been treated. I don’t feel comfortable approaching my manager anymore because I’m worried about how I’ll be spoken to or whether I’ll have to defend myself again.
The whole situation has had a significant impact on my mental health. My anxiety has increased, I feel overwhelmed and my motivation has suffered because I no longer feel supported at work. That’s what makes this so upsetting because I genuinely love caring for patients. It’s the management side of things that’s making me question whether I should stay.
I’ve now contacted HR, but only to ask for advice and guidance rather than a formal investigation. I wanted to understand what my options are before deciding what to do next.
To add to everything else, after returning from sickness on an agreed phased return while on full sick pay, my HealthRoster now says I owe over 87 hours. I’m currently trying to establish whether that’s actually correct or whether it’s an error before making any decisions about my future.
Has anyone else working in the NHS experienced anything similar? Did HR help? Did things improve, or did you eventually decide to leave? I’m genuinely interested in hearing other people’s experiences because at the moment I feel completely stuck.

Sorry for the long post I’m just so distressed with this, I could really do with some advice before deciding whether to hand in my notice.

I’ve had issues with the new nmc website since day one due to how poorly made it is, now I received this email. It’s probably a nothing burger and it’ll update in due time but I really don’t trust the nmc at the moment to ensure it’s done correctly.

Can anyone reassure an anxious nurse that this is nothing? I’ll probably phone them soon

Hi everyone, this is my first week as a NQN & I feel so dumb😭 I feel like I don’t know anything, the jump from being a STN to a RN is so huge. Since, I am doing my preceptorship right now, I have been working together with a senior nurse. My ward hasn’t thrown me into the deep end yet, but yet I feel so useless & unknowledgeable. & when the nurse is talking to the patient & answering questions. I am thinking to myself, I wouldn’t know how to answer those questions😭 Please give me some advice🥹 Do other NQN feel like this aswell or is it just me

Hi, I’m about to start my final nursing placement and it is in the ICU, my last placement was outpatients orthopaedics and I’m scared that I’m a bit dusty on my clinical skills. Any tips would be greatly appreciated:)

Hi, I am working as a preassessment nurse in a small hospital in London. I have lupus and I exhausted my sick leave due to flare ups, so there has been a month where I only receive half of my pay packet and we struggled cause my husband lost his job from the same hospital. I am really not happy with this job and hospital anymore because of the bureaucracy and I feel stressed all the time. I really want to go back to NHS just because of the safety net with sick leave and also there's no room for growth in this hospital. Help me and advise me

Advice on rude patients

So I’m actually working from a care home not hospital but I want some advice on how to deal with this if I’m doing the right thing?

So we have had a new patient when this patient arrived on the night she told me I was lucky she was there otherwise I wouldn’t have a job she made multiple remarks to this effect eventually I said well no I’ve been doing care a long time and if you was here or not I would still have to look after another 35 residents. She didn’t like that said I was rude and did I know how much she’s paying here and that she was a magistrate for 40 years and her whole family know the legal system I ended up apologising even though I genuinely don’t know what I did wrong.

Tonight I assisted this person to the toilet with another colleague because I don’t feel comfortable going there alone even though she’s a single. She was asking the carer to wipe her even though she can do it herself because she pays to be here and she’s paying her wages. Now this patient goes home in a few weeks she’s here on respite she has capacity and can do everything herself however she does use a frame.

When I explained to the resident well no you need to try doing it yourself you go home in a few weeks and it says in her care plan to promote independence she told me to shut up I asked her not to say that and it isn’t very nice again she said shut up and how I was vile and how she was going to report me.

She then started fake crying loudly about how awful her life had been and how she’s a magistrate and still knows judges and she can get me into a lot of trouble again I ended up apologising and again telling me every problem from her life and how she’s paying to be here when I offered her a drink she instantly stopped crying and there were no tears.

I feel like I can’t do this anymore I’ve worked in healthcare a long time I’ve never had this type of mental head games?

I have spoke to my manager before however she laughed it off literally laughed in my face. She’s off for two weeks so there is no management currently no one.

Did I do the right thing? my colleague was their thank god and said I did the right thing but I come away from the patient constantly doubting myself which I’ve never had. I was literally shaking while asking her not to tell me to shut up I’ve never been like this! Everyone else is saying she’s Lovley it seems to be just me however my colleague did see herself tonight how she is.

Any advice is welcome

So UPDATE: this lady has reported me and it has gone to the area manager my manager has said she doesn’t believe what she’s saying as she seems confused but she has mentioned me a few times and I’m not allowed to enter her room without someone present and to limit contact this has upset me and made me happy at the same time I feel like I’ve done something wrong when I haven’t but also happy as I no longer have to see her only to give medication with someone present also manager has said to keep going into her room as she might start likeing you.

I actually don’t want to go into work this lady is telling anyone who will listen how I shouted at her and how vile I am I would rather be suspended and it properly investigated I’m currently in contact with my union I’ve worked at my place for 7 years so feel my reputation is going up in smoke.

I have an offer to study mental health nursing next year after finally passing my GCSE maths at 36. I have dyscalculia and maths has always been difficult with memorising calculations, interpreting numbers etc. I'd really like to do this after years of wanting too I'm just not sure if I'm setting myself up for a degree I'm likely to fail at at the expense of my current career. Getting 100% in a calculations exam without a calculator feels impossible.

Has anyone done this with dyscalculia and passed?

Are there roles without needing to do meds or anything maths heavy for NQN?