Patricia Shull, BHA, RN, has been working in nursing for 45 years. In her long tenure as a registered nurse she has worn many hats, and has served in many leadership positions along the way. Thirty-two years ago she opened an adult day care center in Chester County, Pennsylvania. I interviewed her about her life as a nurse, the role of the nurse in adult day care centers and geriatric care, and about the most rewarding aspects of her job as CEO and president of a nonprofit adult day center. Read on if you’d like to know more about the role of the outpatient adult care nurse.

Tell me a bit about your background in nursing. When did you graduate from a nursing program? How long have you been a nurse?

I graduated as a three-year diploma nurse from Germantown Hospital in Philadelphia, Pennsylvania, in September 1971, and I passed my boards the first time around, becoming a registered nurse (RN) in December 1971. A few years later, I wanted to continue my education, but at that time (back in the dark ages) there was no transfer of college credits toward a bachelor of science in nursing (even though we took six college science courses!). About that time, Eastern College (now Eastern University) was evaluating the coursework from the diploma program and they started awarding up to 60 credits for the diploma program toward a bachelor’s in Health Administration. That was the direction I went, and it has served me well in my current role as president and chief executive officer (CEO) of a nonprofit adult day center for 32 years. 

From a clinical perspective, I’ve done a little bit of everything. I started in med-surg nursing, I worked labor and delivery for a short while, and then I went to a small community hospital. There, I found myself in charge of a one-woman dialysis unit, and as a relief nurse in the combined intensive care unit and cardiac care unit. Later, I served as staff development in a nursing and rehab center, where I fell in love with geriatric nursing. I went on to be the director of nursing of two different skilled nursing facilities. I started an adult day center in Pennsylvania in December 1983, and while doing that I continued to work for five years as weekend nursing supervisor at Bryn Mawr Rehab.

Through my role at Adult Care of Chester County, I have also had the opportunity to serve as chair of the National Adult Day Services Association for two years, serve for seven years on the Board of Directors of CARF (the Commission on Accreditation of Rehabilitation Facilities), and serve as the President of the Pennsylvania Adult Day Services Association. In these leadership roles I worked with nurses and other medical professionals from around the country and learned a great deal. I have been an RN for 45 years.  

Where do you work? What is the facility like, how many “patients” are there?

Adult Care of Chester County is a non-profit organization that provides adult day services at two locations. In my role as president and CEO, I oversee and work in both centers. Our participants (patients) come in each day for care, nursing oversight, activities, and socialization, and then return to family in the afternoon. The participants that attend all need some level of supervision or assistance with activities of daily life (ADLs), or maybe they are not safe home alone. Some people that attend live alone but have adult day and other community supports that watch over and assist them.

People who attend our adult day centers have physical challenges or dementia, cardiac problems, diabetes, and other chronic or progressive illnesses. There are 110 participants currently enrolled at our facilities, with an average of 70 attending each day. Participants attend between two and five days per week based on their needs and the needs of their families. Many family caregivers work, and sending their loved one to the center enables them to work without worry. For other caregivers, it is time to take care of their own health and social needs (respite is key to being able to continue to care for an impaired loved one).

What is the average day like for an adult day care nurse?

Our centers open at 06:30. At least one nurse is always present when participants are present. There are certain routine events each day: we check vital signs, monitor blood glucose and administer insulin on a sliding scale, administer medications, do treatments or wound care, help with lunch and ADLs to assess participant abilities and choking risks. Each day always carries the risk that an “emergency” might arise—for example, a suddenly unresponsive participant who needs emergency care. Sometimes the crisis or illness isn’t as urgent, but still involves assessing a cough or gastrointestinal upset and notifying family of follow-up care needed. Teaching is another important aspect of the geriatric nursing role, and our nurses frequently provide education and teaching on when or why follow-up is needed. Our nurses spend a great deal of time assessing our participants and advocating for them. And, as with any other nursing job, there is documentation—daily, monthly, quarterly. Communication with the on site physical and occupational therapists is also a big part of their day.  

What are the particular challenges of this type of nursing?

The greatest challenge of this type of nursing is that many healthcare professionals don’t recognize the benefits of people attending. With participants in an atmosphere of controlled eating and encouraged activity and exercise, we can help family caregivers of diabetics or CHF (congestive heart failure) keep their loved one on track with nutrition and proper diet. With various exercise and walking programs throughout the day, we promote physical activity that increases stamina and mobility. Our cognitive activities help keep the mind active and more alert. Activity during the day also promotes better sleep for the participant, which ultimately helps the family caregiver get a better night sleep as well. A study by Pennsylvania State University demonstrated the benefits to the family caregiver’s health when their impaired loved one attends an adult day center.  

Who would be good in this role?  What type of person would succeed here?

First and foremost, the nurse in this role must have respect for our seniors and persons with chronic and progressive illness. They must have patience for the behaviors that are exhibited by some people with various types of dementia, and they must have empathy for the family caregivers who are juggling caregiving, family, and work. The person in this role must be willing to be part of an interdisciplinary team that includes the in-house clinical staff and the family, and be able to understand each person’s role within that team.

The successful nurse in this role has excellent assessment skills and can stay calm and make quick decisions in emergent situations; the balance is that he or she must also be happy helping a participant eat or walk. The person that enjoys long-term relationships with participants and their families would certainly excel in this type of nursing care.

What is something you wish people knew about your job?

I wish I could share how good it feels when the family of a participant tells you that your team made it possible for them to keep their mom living at home with them until the very end (because she attended the center until she died or shortly before). I can’t say enough how good it feels that each day, you help each person in your care have a better day than they would have without the work you do, whether it is through direct, hands-on care, or working with their family caregiver or other members of the team.

Laura Kinsella

Laura Kinsella, BSN, RN, CEN, is an emergency room nurse in Washington, DC.

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